Perioperative blood product transfusion of two different perfusion strategies on pediatric patients undergoing aortic arch surgery

Abstract

Simple regional cerebral perfusion (SRCP) or cerebro‐myocardial perfusion (CMP) is selectively used in one‐stage complex aortic arch malformation repair. This analysis was performed to investigate the effect of CMP and SRCP on perioperative blood product consumption, and to evaluate whether these two strategies have different effects on the clinical outcomes. A retrospective analysis of 284 children with complicated aortic malformation from January 2010 to June 2018 was performed. The overall cohort was divided into SRCP group (n = 202) and CMP group (n = 82). A comprehensive comparison of perioperative blood product consumption‐related indexes was performed. Cardiopulmonary bypass time, cardiac arrest time, cooling, and rewarming time in the CMP group were significantly shorter than those in the SRCP group (P < .05). Chest tube time was 3.82 ± 1.33 days in the SRCP group compared to 3.42 ± 0.97 days in the CMP group (P = .005). Moreover, intraoperative platelet (PLT) transfusion volume (mL/kg) and rate (%) were significantly lower in the CMP group (P < .001). Multivariate regression analysis found that intraoperative PLT transfusion was significantly negatively correlated with CMP management [OR = 0.237 (0.110‐0.507), P < .001] and CPB time was independently associated with delayed chest tube removal (>3 days) [OR = 1.010 (1.001‐1.020), P = .031]. In‐hospital mortality and early postoperative adverse events were not significantly different between the two groups. In children with on‐pump complex aortic arch surgeries, CMP is more preferable than SRCP in blood protection. However, overall prognosis was not remarkably different between these two perfusion groups. They are both safe and feasible.

Myocardial Priority Promotes Cardiovascular Recovery for Acute Type A Aortic Dissection Combined with Coronary Artery Disease Undergoing Aortic Arch Surgery

“…The better vascular protection effects of less bleeding, transfusions, and higher postoperative hemoglobin in the MP group was also the probable reason for shortening the posthospital stay. It was similar to pediatric arch surgery, which could reduce chest tube time and platelet transfusion [ 19 ]. Although there are several factors (such as surgical skills, transfusion indications, priming or dilution of CPB circuits, and methods of lost blood collection [ 11 ]) that influence blood loss and transfusion, we thought that the main reason should be incision and cannulation reduction in the MP group, which is consistent with Lyu’s research that a minimally invasive approach could decrease transfusion in patients with type A dissection [ 20 ].…”