Bleeding and Blood Product Utilization in Adults Undergoing Elective Aortic Root Replacement: The impact of Antifibrinolytic Exposure and Aortic Root Prosthesis.

ABSTRACT

A retrospective observational study was carried out to test the hypothesis that bleeding and blood component utilization are significantly associated with aortic root replacement (ARR). The aims of the study were as follows. (1) To determine antifibrinolytic exposure (AFE) in ARR; (2) To determine mediastinal drainage within the first 24 hours after ARR; (3) To determine blood component transfusion within the first 24 hours after ARR; (4) To determine whether AFE affects bleeding and blood component transfusion for ARR; and, (5) To determine whether type of aortic root prosthesis affects bleeding and/or blood component transfusion after ARR. All adults undergoing elective ARR from 1996-2001 at the Hospital of the University of Pennsylvania were included in the study. Cohort size was 61. Average age was 49.1 years. AFE was 52% 23.0% aminocaproic acid, and 29% aprotinin. Mediastinal drainage averaged 384 ml for the first 24 hours. Transfusion in the first 24 hours averaged <1 unit red cells, <1 unit plasma, and <16-pack of platelets. Mediastinal drainage and blood component transfusion were not significantly related to AFE or type of surgical prosthesis. Based on these findings the hypothesis is rejected. The protocol for ARR at our institution is associated with excellent haemostatic outcome, regardless of AFE or type of aortic root prosthesis. Further clinical research in haemostatic outcome after thoracic aortic surgery should be directed at more extensive aortic procedures such as aortic arch repair with deep hypothermic circulatory arrest.