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Original Article   

The Journal of Cardiovascular Surgery 2022 Aug 01

DOI: 10.23736/S0021-9509.22.12339-6

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Impact of fluid balance and blood transfusion during extracorporeal circulation on outcome for acute type A aortic dissection surgery

Jing LI 1 , Andrea STADLBAUER 1, Anton HELLER 1, Zhiyang SONG 2, Walter PETERMICHL 3, Maik FOLTAN 1, Christof SCHMID 1, Simon SCHOPKA 1

1 Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany; 2 Institute of Mathematics, Ludwig-Maximilian University Munich, Munich, Germany; 3 Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany


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BACKGROUND: In thoracic aortic surgery, fluid replacement and blood transfusion during extracorporeal circulation (ECC) are associated with increased coagulopathy, elevated inflammatory response, and end-organ dysfunction. The optimal strategy has not been established in this regard. The aim of this study was to evaluate the effect of the fluid balance during ECC in thoracic aortic dissection surgery on outcome.
METHODS: Between 2009 and 2020, 358 patients suffering from acute type A aortic dissection (ATAAD) underwent aortic surgery at our heart center. In-hospital mortality, major complications (postoperative stroke, respiratory failure, heart failure, acute renal failure), and follow-up mortality were assessed. Logistic regression analysis was used to identify whether fluid balance and blood transfusion during ECC were risk factors for occurring adverse events.
RESULTS: The in-hospital mortality amounted to 20.4%. Major complications included temporary neurologic deficit in 13.4%, permanent neurologic deficit in 6.1%, acute renal failure in 32.7%, prolonged ventilation for respiratory failure in 17.9%, and acute heart failure in 10.9% of cases. At a mean of 42 months after discharge of 285 survivors, follow-up mortality was 13.3%. Multivariate analysis revealed major complications as well as the risk of in-hospital and follow-up mortality to increase with fluid balance and blood transfusion during ECC.
CONCLUSIONS: Fluid balance and blood transfusion during ECC present with predictive potential concerning the risk of postoperative adverse events.


KEY WORDS: Type A aortic dissection; ECC; Fluid balance; Blood transfusion

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