Association of intraoperative transfusion of blood products with postoperative outcomes and midterm survival in acute type A aortic dissection repair.

Objective: The study objective was to evaluate the impact of intraoperative blood product on postoperative outcomes and midterm survival in acute type A aortic dissection repair.

Methods: Patients undergoing open acute type A aortic dissection repair from January 2010 to April 2020 were divided into 2 groups: patients receiving intraoperative blood products and no intraoperative blood products, with a final propensity-matched cohort of 90 matched pairs by matching sex, age, body mass index, preoperative hemoglobin, coronary artery disease, renal failure, stroke, prior cardiac surgery, cardiogenic shock, cardiopulmonary bypass time, crossclamp time, peripheral vascular disease, and aortic insufficiency.

Results: Patients were similar in demographic and preoperative characteristics. The complexity of the surgery, including the extent of aortic root and arch repair, was similar between the groups. The intraoperative blood product group had longer intubation time (77 hours vs 44 hours,  = .023), longer postoperative (14 vs 10 days,  = .0001) and total (15 vs 10 days,  < .0001) length of stays, and a higher rate of acute renal failure postoperatively (16.7% vs 6.7%,  = .037). The 6-year survival was similar between the intraoperative blood product group and no intraoperative blood product group (76.5% vs 83.3%,  = .48). The multivariate Cox proportional hazard model showed a statistically insignificant hazard ratio of 1.27 in the intraoperative blood product group for midterm mortality (95% CI, 0.64-2.54,  = .50).

Conclusions: Intraoperative blood product use during acute type A aortic dissection repair did not impact midterm survival but increased postoperative complications. Intraoperative blood product transfusion can be safely and cautiously used during acute type A aortic dissection repair.