A Systematic Bloodless Approach For Acute Type A Aortic Dissection Surgical Treatment And The Short-term Outcome

Objective:Aortic dissection is a major disease of acute aortic syndrome.Acute Stanford type A aortic dissection（ATAAD）is most fatal type of aortic dissection with extremely high mortality,requiring surgical intervention which has been proven the only effective approach.ATAAD surgery involves complex reconstruction of aortic arch with multiple anastomoses,deep hypothermia circulatory arrest,long cardiopulmonary bypass and circulatory arrest time and coagulopathy.Thus,the surgery is the most challenging section in the treatment strategy of ATAAD.ATAAD is considered by default requiring massive transfusion for surgery.Currently50-60% of cardiac surgery requires intraoperative transfusion,which introduces the risk of transfusion-related complications and burdens the critical blood product supply for healthcare.This research investigates the impact of transfusion on ATAAD patients undergone surgical treatment by comparing the perioperative data of 2 groups of patients accepted or waived transfusion.The aim is to optimize the treatment of ATAAD to improve the outcome and prognosis of patients and relieve the critical situation of blood product supply for healthcare,by summarizing our experience in practicing transfusion-free ATAAD surgical treatment.Methods:From August 2016 to June 2020,326 patients underwent ATAAD surgery in our center using a systematic approach,which mainly included the following: Liu’s aortic root repair technique,Liu’s aortic arch inclusion technique with frozen elephant trunk,moderate to mild hypothermia circulatory arrest,and application of centrifugal pump in cardiopulmonary bypass circuit.Patients were divided into two groups according to whether they had blood product transfusion during their hospital stay: transfusion group and bloodless group.Preoperative,intraoperative,and postoperative outcomes were compared between two groups.Results:152 patients were included in the transfusion group and 174 patients in the bloodless group;the bloodless rate was 53.37%.98 patients in the transfusion group received intraoperative blood transfusion and the 54 patients postoperative blood transfusion.Patients in the transfusion group were significantly older than patients in the bloodless group,and there were more patients with preoperative anemia and malperfusion in the transfusion group.Overall in-hospital mortality was 5.21%（17/326）,with 3 mortalities（1.72%）in the bloodless group and 14 mortalities（9.21%）in the transfusion group（p<0.05）.The transfusion group had significantly more MODS,sepsis and tracheotomy,and longer intensive care unit stays.Hb levels of patients between the two groups were similar at tested time points.Conclusions:With the implementation of systematic approach,bloodless ATAAD surgery can be safely applied in ATAAD patients.More efforts should be made to surgical technique modifications,application of moderate to mild hypothermia circulatory arrest,usage of centrifugal pump in cardiopulmonary bypass circuit and a restrictive blood transfusion protocol.