Reducing Blood Transfusion in Aortic Surgery: A Novel Approach

Background. We introduced a new algorithm utilizing a patient's own platelet rich plasma and factor concentrates to better manage coagulopathy in aortic surgery under circulatory arrest. This study compares the outcomes of the patients treated with a new algorithm with those of patients managed with our traditional approach. Methods. The data of 247 consecutive patients who had aortic surgery were analyzed. The 158 patients (group 1) who were managed with our usual algorithm were compared with the 89 patients (group 2) who were treated with the novel algorithm consisting of utilization of the patient's own platelet rich plasma, fibrinogen, and prothrombin cell concentrates. Differences in transfusion and intensive care unit stay were analyzed. Univariate and multivariable robust regression analyses were performed. Results. In comparison with group 1, patients in group 2 had significantly reduced need for transfusion of red cells (7.9 +/- 8.6 vs 3.5 +/- 3.8 units, P < .001). Postoperative intubation time was reduced from a mean of 42 hours to a mean of 12 hours (P < .001). The time to medical discharge from the intensive care unit was reduced from a mean of 7 days to a mean of 5 days (P < .001), favoring the new algorithm. After adjustment for demographics and comorbidities, the novel algorithm remained significantly associated with a reduction in units of red blood cells transfused (robust parameter estimate, L1.14; P = .027) and blood products transfused (robust parameter estimate, L5.11; P < .001). Conclusions. Using autologous plasma and factor concentrates to reverse coagulopathy in aortic surgery significantly reduces blood product transfusion. (C) 2019 by The Society of Thoracic Surgeons