Blood transfusion in aortic root surgery impairs midterm survivalCentral MessagePerspective
Objective: To evaluate the effect of perioperative allogeneic packed red blood cell (RBC) transfusion during aortic root replacement. Method: We reviewed patients undergoing aortic root replacement at our institution between March 2014 and April 2020. In total, 760 patients underwent aortic root rep...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266627362300013X |
| _version_ | 1827979900743581696 |
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| author | Alex R. Dalal, MD Albert J. Pedroza, MD Aravind Krishnan, MD Yan Min, MD, MS Emily Tognozzi, PA-C Nobu Yokoyama, MD Ken Nakamura, MD Olivia R. Mitchel, BS Michael Baiocchi, PhD Y. Joseph Woo, MD John W. MacArthur, MD Michael P. Fischbein, MD, PhD |
| author_facet | Alex R. Dalal, MD Albert J. Pedroza, MD Aravind Krishnan, MD Yan Min, MD, MS Emily Tognozzi, PA-C Nobu Yokoyama, MD Ken Nakamura, MD Olivia R. Mitchel, BS Michael Baiocchi, PhD Y. Joseph Woo, MD John W. MacArthur, MD Michael P. Fischbein, MD, PhD |
| author_sort | Alex R. Dalal, MD |
| collection | DOAJ |
| description | Objective: To evaluate the effect of perioperative allogeneic packed red blood cell (RBC) transfusion during aortic root replacement. Method: 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. Results: 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%]; P = .01), postoperative hemodialysis (9/159 [5.7%] vs 0/159 [0%]; P = .003), reoperation for mediastinal hemorrhage (9/159 [5.7%] vs 0/159 [0%]; P = .003), and longer intensive care unit and hospital length of stay (3 vs 2 days and 8 vs 6 days respectively; P < .001). Thirty-day operative mortality after propensity score matching was similar between the cohorts (1.9%; 3/159 vs 0%; P = .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%] P = .035). Conclusions: 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. |
| first_indexed | 2024-04-09T21:44:05Z |
| format | Article |
| id | doaj.art-07327f7dcdd3474bb97c01fa04c96be2 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-09T21:44:05Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-07327f7dcdd3474bb97c01fa04c96be22023-03-25T05:15:35ZengElsevierJTCVS Open2666-27362023-03-0113919Blood transfusion in aortic root surgery impairs midterm survivalCentral MessagePerspectiveAlex R. Dalal, MD0Albert J. Pedroza, MD1Aravind Krishnan, MD2Yan Min, MD, MS3Emily Tognozzi, PA-C4Nobu Yokoyama, MD5Ken Nakamura, MD6Olivia R. Mitchel, BS7Michael Baiocchi, PhD8Y. Joseph Woo, MD9John W. MacArthur, MD10Michael P. Fischbein, MD, PhD11Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CalifDepartment of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CalifDepartment of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif; Address for reprints: Michael P. Fischbein, MD, PhD, Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr, Falk CVRB, Stanford, CA 94305.Objective: To evaluate the effect of perioperative allogeneic packed red blood cell (RBC) transfusion during aortic root replacement. Method: 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. Results: 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%]; P = .01), postoperative hemodialysis (9/159 [5.7%] vs 0/159 [0%]; P = .003), reoperation for mediastinal hemorrhage (9/159 [5.7%] vs 0/159 [0%]; P = .003), and longer intensive care unit and hospital length of stay (3 vs 2 days and 8 vs 6 days respectively; P < .001). Thirty-day operative mortality after propensity score matching was similar between the cohorts (1.9%; 3/159 vs 0%; P = .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%] P = .035). Conclusions: 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.http://www.sciencedirect.com/science/article/pii/S266627362300013Xaortic root replacementblood transfusionmidterm survivaloutcomes |
| spellingShingle | Alex R. Dalal, MD Albert J. Pedroza, MD Aravind Krishnan, MD Yan Min, MD, MS Emily Tognozzi, PA-C Nobu Yokoyama, MD Ken Nakamura, MD Olivia R. Mitchel, BS Michael Baiocchi, PhD Y. Joseph Woo, MD John W. MacArthur, MD Michael P. Fischbein, MD, PhD Blood transfusion in aortic root surgery impairs midterm survivalCentral MessagePerspective JTCVS Open aortic root replacement blood transfusion midterm survival outcomes |
| title | Blood transfusion in aortic root surgery impairs midterm survivalCentral MessagePerspective |
| title_full | Blood transfusion in aortic root surgery impairs midterm survivalCentral MessagePerspective |
| title_fullStr | Blood transfusion in aortic root surgery impairs midterm survivalCentral MessagePerspective |
| title_full_unstemmed | Blood transfusion in aortic root surgery impairs midterm survivalCentral MessagePerspective |
| title_short | Blood transfusion in aortic root surgery impairs midterm survivalCentral MessagePerspective |
| title_sort | blood transfusion in aortic root surgery impairs midterm survivalcentral messageperspective |
| topic | aortic root replacement blood transfusion midterm survival outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S266627362300013X |
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