title: Blood conservation strategies can be applied safely to high-risk complex aortic surgery.
abstract: OBJECTIVE
  The present study aimed to evaluate the effect of blood conservation strategies on patient outcomes after aortic surgery.
  
  
  METHODS
  Retrospective cohort analysis of prospective data.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Patients undergoing thoracic aortic surgery.
  
  
  METHODS
  One hundred thirty-two consecutive high-risk patients (mean EuroSCORE 10.4%) underwent thoracic aortic aneurysm or dissection repair from January 2010 to September 2011. A blood conservation strategy (BCS) focused on limitation of hemodilution and tolerance of perioperative anemia was used in 57 patients (43.2%); the remaining 75 (56.8%) patients were managed by traditional methods. Mortality, major complications, and red blood cell transfusion requirements were assessed. Independent risk factors for clinical outcomes were determined by multivariate analyses.
  
  
  RESULTS
  Hospital mortality was 9.8% (13 of 132). Lower preoperative hemoglobin was an independent predictor of mortality (p<0.01, odds ratio [OR] 1.7). Major complications were associated with perioperative transfusion: 0% complication rate in patients receiving<2 units of packed red blood cells versus 32.3% (20 of 62) in patients receiving ≥2 units. The blood conservation strategy had no significant impact on mortality (p = 0.4) or major complications (p = 0.9) despite the blood conservation patients having a higher incidence of aortic dissection and urgent/emergent procedures and lower preoperative and discharge hemoglobin. In patients with aortic aneurysms, BCS patients received 1.5 fewer units of red blood cells (58% reduction) than non-BCS patients (p = 0.01). Independent risk factors for transfusion were lower preoperative hemoglobin (p<0.01, OR 1.5) and lack of BCS (p = 0.02, OR 3.6).
  
  
  CONCLUSIONS
  Clinical practice guidelines for blood conservation should be considered for high-risk complex aortic surgery patients.
authors.affiliation: Departments of Cardiothoracic Surgery.
authors.forename: David W
authors.initials: DW
authors.lastname: Yaffee
authors.affiliation: Departments of Cardiothoracic Surgery.
authors.forename: Abe
authors.initials: A
authors.lastname: DeAnda
authors.affiliation: Anesthesiology, NYU Langone Medical Center, New York, NY.
authors.forename: Jennie Y
authors.initials: JY
authors.lastname: Ngai
authors.affiliation: Departments of Cardiothoracic Surgery.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ursomanno
authors.affiliation: Departments of Cardiothoracic Surgery.
authors.forename: Annette E
authors.initials: AE
authors.lastname: Rabinovich
authors.affiliation: Departments of Cardiothoracic Surgery.
authors.forename: Alison F
authors.initials: AF
authors.lastname: Ward
authors.affiliation: Departments of Cardiothoracic Surgery.
authors.forename: Aubrey C
authors.initials: AC
authors.lastname: Galloway
authors.affiliation: Departments of Cardiothoracic Surgery. Electronic address: eugene.grossi@nyumc.org.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D057668:Bloodless Medical and Surgical Procedures / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors
keywords: anemia; aortic surgery; blood conservation; transfusion