Chu M W A, Losenno K L, Moore K, Berta D, Hewitt J, Ralley F
Division of Cardiac Surgery, Department of Surgery, University of Western Ontario & Lawson Health Research Institute, Ontario, Canada.
Perfusion. 2013 Jul;28(4):315-21. doi: 10.1177/0267659113479816. Epub 2013 Feb 22.
Ascending and aortic arch surgery is associated with higher levels of blood loss and subsequent need for allogeneic blood transfusions. We hypothesized that aggressive, comprehensive blood conservation strategies may limit the need for transfusions and, subsequently, improve postoperative outcomes.
Over a five-year period, 189 patients underwent proximal aortic surgery at our institution. Fifty-one patients underwent surgery using a comprehensive blood conservation strategy (BCS), including preoperative hemoglobin optimization, antifibrinolytic therapy, intraoperative acute normovolemic hemodilution, cell salvage and meticulous surgical technique. The remaining 138 patients underwent surgery using conventional techniques (CONV).
Patients in the BCS group required fewer transfusions during their hospital stay compared to the conventional group (56.9% vs. 72.5%, p=0.041). When examining elective cases, this trend widens, with 40.0% of BCS patients requiring any transfusions compared to 72.9% patients in the conventional group (p=0.001). Red cell (47.1% vs. 62.3%, p=0.06), plasma (43.1% vs. 61.6%, p=0.02) and platelets (27.5% vs. 47.8%, p=0.01) were also less frequently required in the BCS group than the conventional group, respectively. When a transfusion was required, patients in the BCS group received significantly fewer units of red blood cells (2.8 ± 7.0 units) than the conventional group (5.81 ± 9.5 units; p=0.039). Mortality was similar in both groups (BCS 7.8%, conventional 10.9%, p=0.54); however, there was significantly less morbidity in the BCS group, using a composite of any of 10 major postoperative complications (23.5% vs. 39.1%; p=0.046). Median intensive care unit (ICU) and hospital lengths of stay were 2 and 7 days in the BCS group and 2 and 8 days in the CONV group (p=0.15), respectively.
The aggressive use of a comprehensive blood conservation strategy in ascending and aortic arch surgery can significantly reduce the need for blood transfusions and is associated with less postoperative morbidity. Further evaluation with a randomized, controlled trial is warranted.
升主动脉和主动脉弓手术会导致较高的失血量以及随后对异体输血的需求。我们推测，积极、全面的血液保护策略可能会减少输血需求，并进而改善术后结局。
在五年期间，189例患者在我们机构接受了近端主动脉手术。51例患者采用全面血液保护策略（BCS）进行手术，包括术前血红蛋白优化、抗纤溶治疗、术中急性等容血液稀释、细胞回收和精细的手术技术。其余138例患者采用传统技术（CONV）进行手术。
与传统组相比，BCS组患者住院期间需要输血的次数更少（56.9%对72.5%，p=0.041）。在检查择期病例时，这种趋势更加明显，BCS组40.0%的患者需要输血，而传统组为72.9%（p=0.001）。BCS组红细胞（47.1%对62.3%，p=0.06）、血浆（43.1%对61.6%，p=0.02）和血小板（27.5%对47.8%，p=0.01）的需求也分别比传统组少。当需要输血时，BCS组患者接受的红细胞单位明显少于传统组（2.8±7.0单位对5.81±9.5单位；p=0.039）。两组的死亡率相似（BCS组7.8%，传统组10.9%，p=0.54）；然而，BCS组的发病率明显较低，采用10种主要术后并发症中的任何一种进行综合评估（23.5%对39.1%；p=0.046）。BCS组重症监护病房（ICU）和住院时间的中位数分别为2天和7天，CONV组为2天和8天（p=0.15）。
在升主动脉和主动脉弓手术中积极采用全面血液保护策略可显著减少输血需求，并与较低的术后发病率相关。有必要通过随机对照试验进行进一步评估。
