Dalal Alex R, Pedroza Albert J, Krishnan Aravind, Min Yan, Tognozzi Emily, Yokoyama Nobu, Nakamura Ken, Mitchel Olivia R, Baiocchi Michael, Woo Y Joseph, MacArthur John W, Fischbein Michael P
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, Calif.
JTCVS Open. 2023 Jan 16;13:9-19. doi: 10.1016/j.xjon.2023.01.006. eCollection 2023 Mar.
To evaluate the effect of perioperative allogeneic packed red blood cell (RBC) transfusion during aortic root replacement.
We reviewed patients undergoing aortic root replacement at our institution between March 2014 and April 2020. In total, 760 patients underwent aortic root replacement, of whom 442 (58%) received a perioperative RBC transfusion. Propensity score matching was used to account for baseline and operative differences resulting in 159 matched pairs. All-cause mortality was assessed with Kaplan-Meier curves. Data were obtained from our institutional Society of Thoracic Surgeons database and chart review.
After propensity score matching, the RBC-transfused and -nontransfused groups were similar for all preoperative characteristics. Cardiopulmonary bypass time, crossclamp time, and lowest operative temperature were similar between the transfused and nontransfused groups (standardized mean difference <0.05). RBC transfusion was associated with more frequent postoperative ventilation greater than 24 hours (36/159 [23%] vs 19/159 [12%]; = .01), postoperative hemodialysis (9/159 [5.7%] vs 0/159 [0%]; = .003), reoperation for mediastinal hemorrhage (9/159 [5.7%] vs 0/159 [0%]; = .003), and longer intensive care unit and hospital length of stay (3 vs 2 days and 8 vs 6 days respectively; < .001). Thirty-day operative mortality after propensity score matching was similar between the cohorts (1.9%; 3/159 vs 0%; = .2), and 5-year survival was reduced in the RBC transfusion cohort (90.2% [95% confidence interval, 84.1%-96.7%] vs 97.1% [95% confidence interval, 92.3%-100%] = .035).
Aortic root replacement frequently requires RBC transfusion during and after the operation, but even after matching for observed preoperative and operative characteristics, RBC transfusion is associated with more frequent postoperative complications and reduced midterm survival.
评估主动脉根部置换术中围手术期异体浓缩红细胞（RBC）输注的效果。
我们回顾了2014年3月至2020年4月在本机构接受主动脉根部置换术的患者。共有760例患者接受了主动脉根部置换术，其中442例（58%）接受了围手术期RBC输注。采用倾向评分匹配法来考虑基线和手术差异，最终得到159对匹配病例。采用Kaplan-Meier曲线评估全因死亡率。数据来自我们机构的胸外科医师协会数据库和病历审查。
倾向评分匹配后，RBC输注组和未输注组在所有术前特征方面相似。输血组和未输血组之间的体外循环时间、主动脉阻断时间和最低手术温度相似（标准化均差<0.05）。RBC输注与术后通气时间超过24小时更为频繁相关（36/159 [23%] 对比19/159 [12%]；P = 0.01）、术后血液透析（9/159 [5.7%] 对比0/159 [0%]；P = 0.003）、因纵隔出血再次手术（9/159 [5.7%] 对比0/159 [0%]；P = 0.003）以及重症监护病房和住院时间延长（分别为3天对比2天和8天对比6天；P < 0.001）。倾向评分匹配后的30天手术死亡率在两组之间相似（1.9%；3/159对比0%；P = 0.2），RBC输注组的5年生存率降低（90.2% [95%置信区间，84.1%-96.7%] 对比97.1% [95%置信区间，92.3%-100%]；P = 0.035）。
主动脉根部置换术在手术期间和术后经常需要RBC输注，但即使在对观察到的术前和手术特征进行匹配后，RBC输注仍与更频繁的术后并发症和中期生存率降低相关。
