The use of blood and blood products in aortic surgery is associated with adverse outcomes

Objective: To report long-term outcomes after deep hypothermic circulatory ar-rest (DHCA) with or without perioperative blood or blood products. Methods: All patients who underwent proximal aortic surgery with DHCA from 2011 to 2018 were propensity matched according to baseline characteristics. Primary outcomes included short-and long-term mortality. Stratified Cox regression anal-ysis was performed for significant associations with survival. Results: A total of 824 patients underwent aortic replacement requiring circulatory arrest. After matching, there were 224 patients in each arm (transfusion and no transfusion). All baseline characteristics were well matched, with a standardized mean difference (SMD) <0.1. Preoperative hematocrit (41.0 vs 40.6; SMD = 0.05) and ejection fraction (57.5% vs 57.0%; SMD = 0.08) were similar be-tween the no transfusion and blood product transfusion cohorts. Rate of aortic dissection (42.9% vs 45.1%; SMD = 0.05), hemiarch replacement (70.1% vs 70.1%; SMD = 0.00), and total arch replacement (21.9% vs 23.2%; SMD = 0.03) were not statistically different. Cardiopulmonary bypass and cross-clamp time were higher in the blood product transfusion cohort (P <.001). Operative mortality (9.4% vs 2.7%; P = .003), stroke (7.6% vs 1.3%; P = .001), reoperation rate, pneu-monia, prolonged ventilation, and dialysis requirements were significantly higher in the transfusion cohort (P < .001). In stratified Cox regression, transfusion was an independent predictor of mortality (hazard ratio, 2.62 [confidence interval, 1.47-4.67]; P = .001). One-and 5-year survival were significantly reduced for the trans-fusion cohort (P < .001). Conclusions: In patients who underwent aortic surgery with DHCA, perioperative transfusions were associated with poor outcomes despite matching for preopera-tive baseline characteristics. (J Thorac Cardiovasc Surg 2023;165:544-51)