Contemporary Patient Blood Management in Acute Type A Aortic Dissections: Reducing Intraoperative Blood Product Usage and Waste

P0093 

Abstract Submission 

Omar Sharaf (1), Patrick Kohtz (1), Alexis Oglesby (1), Mary Michael (1), Cynthia Garvan (1), Bruce Spiess (1), Melissa Burger (1), George Arnaoutakis (2), Daniel Demos (1), Eric Jeng (1), Tomas Martin (1), Thomas Beaver (1)

(1) University of Florida Health, Gainesville, FL, (2) University of Texas at Austin, Austin, TX

Omar Sharaf    -  Contact Me
University of Florida Health

Patrick Kohtz    -  Contact Me
University of Florida Health

Alexis Oglesby    -  Contact Me
University of Florida Health

Mary Michael    -  Contact Me
University of Florida Health

Cynthia Garvan    -  Contact Me
University of Florida Health

Bruce Spiess    -  Contact Me
University of Florida Health

Melissa Burger    -  Contact Me
University of Florida Health

*George Arnaoutakis    -  Contact Me
University of Texas at Austin

Daniel Demos    -  Contact Me
University of Florida Health

Eric Jeng    -  Contact Me
University of Florida Health

*Tomas Martin    -  Contact Me
University of Florida Health

*Thomas Beaver    -  Contact Me
University of Florida Health

Omar Sharaf    -  Contact Me
N/A

Objective
Type A aortic dissection (TAAD) repair produces a significant coagulopathy. Blood product administration, especially fresh frozen plasma (FFP) and platelets, is associated with dose-dependent pulmonary complications, stroke, and mortality. We compared intraoperative blood product usage/waste in TAAD repair before and after implementation of a contemporary patient blood management (PBM) program.

Methods
Single-center retrospective review of adults (≥18 years) with acute TAAD repair between April 4, 2018 and December 29, 2019 (controls) and June 2, 2021 and June 19, 2022 (PBM group). The PBM program included point-of-care viscoelastic testing, education to reduce transfusion, guided concentrated fibrinogen administration and monitoring to reduce blood product waste (ordered but not administered). Statistical analysis included Chi-Square tests for categorical variables and Wilcoxon two-sample tests for continuous variables.

Results
There were 142 patients with blood product data available, including 74 (52%) historical control patients and 68 (48%) PBM patients. Mean age for cohort was 59.0±13.7 years. PBM patients had higher body mass index (31.3±6.9 versus 29.3±5.6, p=0.055), lower preoperative hemoglobin (12.5±2.3 versus 13.2±1.8, p=0.040), and less peripheral vascular disease (26.8% [n=15] versus 46.4% [n=32], p=0.025). PBM group had more complex operations with more zone 2 debranchings (50.0% [n=34] versus 27.0% [n=20], p=0.005) and fewer hemi-arch procedures (39.7% [n=27] versus 63.5% [n=47], p=0.005). Fewer patients in the PBM group had intraoperative FFP transfusions (1.5% [n=1] versus 18.9% [n=14], p<0.001) and Factor 7 transfusions (0% [n=0] versus 8.1% [n=6], p=0.016) with more prothrombin complex concentrate (PCC) (41.2% [n=28] versus 18.9% [n=14], p=0.004) and more fibrinogen concentrate (5.9% [n=4] versus 0% [n=0], p=0.034). Despite higher surgical complexity in the PBM cohort, there were no differences in major complications (stroke, tracheostomy, dialysis) or mortality and no differences in the percentage of patients transfused with red blood cells (RBCs), cryoprecipitate, platelets, or cell salvage blood. Blood product waste was lower in the PBM group for the four principal blood products (RBCs, FFP, platelets, cryoprecipitate).

Conclusions
A contemporary Patient Blood Management program in acute TAAD with point-of-care viscoelastic testing reduced FFP transfusion and blood product waste without any adverse effects on postoperative outcomes.

Dissection