Prospective evaluation of minimal blood use for ascending aorta and aortic arch operations

The feasibility, safety, and impact on postoperative hospital stay of performing ascending aorta and aortic arch operations without homologous blood transfusions have not been evaluated. Sixty consecutive patients, 38 (63%) of whom also had aortic valve replacements and 17 (28%) of whom also had coronary artery bypass grafting, were evaluated for participation in blood conservation measures. Of the 45 who were able to use blood conservation techniques, 87% (39/45) required no intraoperative and 69% (31/45) required no in-hospital homologous blood transfusions. The 30-day survival rate was 98.3% (59/60), and no patient sustained a new stroke, neurologic cognitive deficit, or infection. Multivariate analysis of the 60 patients showed that the predictors of in-hospital homologous transfusion were (p < 0.05) age, cardiopulmonary bypass time, and postoperative chest tube drainage. Preoperative autologous blood donation was associated with a significantly lower risk of homologous transfusion (p = 0.0006). Indeed, patients participating in blood conservation techniques had a significantly (p < 0.05) lower incidence of homologous transfusions, required less intraoperative shed blood washing, were extubated earlier, gained less weight, had shorter hospital stays, and were discharged in a better dyspnea functional class. Most major elective cardiovascular operations on the ascending aorta and aortic arch can be safely performed without homologous transfusions.