State-of-the-art blood conservation strategies following repair of aortic aneurysms and acute aortic dissection

Department of Cardiothoracic Surgery, Guy’s and St Thomas’ Hospital, London, United Kingdom Correspondence: Dr Rizwan Attia, Department of Cardiothoracic Surgery, 6th Floor East Wing, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom. Telephone 44-0-207-188-0214, fax 44-0-207-188-1006, e-mail [email protected] Patients surgically treated for thoracic aortic aneurysms, acute aortic syndromes encompassing type A intramural hematoma, penetrating aortic ulcers and acute type A aortic dissection area at an increased risk for blood loss that can complicate surgical repair (1) and lead to life-threatening coagulopathy (2). Major blood loss is defined as a loss of ≥20% total blood volume. Five to seven percent of cardiac surgery procedures are associated with severe bleeding and up to 50% of patients require blood transfusions (3). This increases complication rates, length of intensive care unit (ICU) stay, incidence of multisystem organ failure, hospital stay and mortality. There are multiple factors that are responsible including patient hypothermia, hemodilution, fibrinolysis, platelet dysfunction, and activation of a proinflammatory coagulopathic state due to surgery and cardiopulmonary bypass (CPB). The beneficial effect of blood transfusion needs to be carefully balanced to avoid potential adverse reactions and complications such as transfusion reactions, transmitted infections, metabolic disequilibration, acute lung injury and negative impact on immunological function (4). This has led to the development of multiple algorithms that aim to reduce blood loss, promote blood conservation and aid rapid hemostasis. The present review discusses wide-ranging current multimodal strategies deployed pre-, intraand postoperatively after complex aortic surgery to minimize transfusion and blood product use.