Impact of Cooling Strategies on Transfusion Requirements in Aortic Hemiarch Surgery

Anthony V. Norman; Sanjana Challa; Genevieve Lyons; Alexander M. Wisniewski; Raymond J. Strobel; Michael Mazzeffi; Mark Joseph; Daniel Tang; Ramesh Singh; Michael C. Kontos; Mohammed Quader; Kenan Yount; Nicholas R. Teman; Ourania Preventza; Jared P. Beller

doi:10.1055/a-2693-4175

AORTA, Inhaltsverzeichnis

CC BY 4.0 · Aorta (Stamford) 2025; 13(02): 056-064
DOI: 10.1055/a-2693-4175

Original Research Article

Impact of Cooling Strategies on Transfusion Requirements in Aortic Hemiarch Surgery

Autoren

Anthony V. Norman

¹Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia
Sanjana Challa

¹Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia
Genevieve Lyons

²Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
Alexander M. Wisniewski

¹Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia
Raymond J. Strobel

¹Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia
Michael Mazzeffi

³Department of Anesthesia, University of Virginia, Charlottesville, Virginia
Mark Joseph

⁴Department of Cardiothoracic Surgery, Carilion Clinic, Roanoke, Virginia
Daniel Tang

⁵Department of Cardiothoracic Surgery, INOVA Heart and Vascular Institute, Falls Church, Virginia
Ramesh Singh

⁵Department of Cardiothoracic Surgery, INOVA Heart and Vascular Institute, Falls Church, Virginia
Michael C. Kontos

⁶Department of Cardiac Surgery, Virginia Commonwealth University, Richmond, Virginia
Mohammed Quader

⁶Department of Cardiac Surgery, Virginia Commonwealth University, Richmond, Virginia
Kenan Yount

¹Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia
Nicholas R. Teman

⁷Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
Ourania Preventza

¹Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia
Jared P. Beller

¹Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia

Abstract

Background

Deep hypothermic circulatory arrest (DHCA) is associated with coagulopathy but facilitates aortic arch surgery. Conflicting data suggest moderate hypothermic circulatory arrest (MHCA) may reduce transfusion requirements. We hypothesized MHCA would reduce transfusion requirements.

Methods

We studied patients undergoing aortic hemiarch surgery for nondissected, aneurysmal disease from July 2014 to May 2023 utilizing a multicenter collaborative. Patients were stratified by DHCA (14.1–20°C) and MHCA (20.1–28°C). Packed red blood cells (pRBC), fresh frozen plasma (FFP), cryoprecipitate, and platelet transfusion requirements were assessed. A negative binomial model accounting for hospital random effect was fitted to identify risk factors for increased transfusion requirements.

Results

Of the 451 patients undergoing hemiarch surgery, 373 (83%) had MHCA and 78 (17%) had DHCA. MHCA patients had shorter cardiopulmonary bypass (135 minutes [105, 182] vs. 216 minutes [183, 263], p < 0.001) and circulatory arrest times (12 minutes [8, 17] vs. 21 minutes [16, 34], p < 0.001). MHCA patients received fewer pRBC (0 [0, 1] vs. 1 [0, 3], p < 0.001), FFP (0 [0, 3] vs. 2 [0, 4], p = 0.003), cryoprecipitate (1 [0, 1] vs. 1 [0, 2], p = 0.045), and platelet transfusions (0 [0, 1] vs. 2 [0, 2], p < 0.001). Unadjusted operative mortality was lower in the MHCA group (1.9 vs. 7.7%, p < 0.01). After risk adjustment, MHCA was associated with reduced FFP transfusion requirements (β = −0.48, SE = 0.2, p = 0.017). Increasing bypass time per minute was associated with increased pRBC (β = +0.01, 95% CI = 0.006–0.013, p < 0.001), FFP (β = +0.006, 95% CI = 0.004–0.009, p < 0.001), cryoprecipitate (β = +0.008, 95% CI = 0.005–0.01, p < 0.001), and platelet transfusions (β = +0.009, 95% CI = 0.006–0.011, p < 0.001).

Conclusion

MHCA was associated with decreased mortality and FFP transfusions in aortic hemiarch repair. MHCA may mitigate transfusion needs via shorter cardiopulmonary bypass time compared with DHCA.

Keywords

hypothermia - circulatory - blood - transfusion - aorta

Volltext

Referenzen

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