Transcript Slide 1
Hematocrit During the Cardiopulmonary Bypass: Impact
on Clinical Outcome During Ascending Aortic Surgery
SF Zhou MD1, AL. Estrera MD2, T Pawelek MD1, C Ignacio MD1, S
Panthayi MD1, MD; K Shebaclo BS1, H Safi MD2, R Sheinbaum MD1
Department of Anesthesia1
Department of Cardiothoracic and Vascular Surgery2
The University of Texas Medical School at Houston
Memorial Hermann Heart & Vascular Institute
Introduction
Blood transfusions worsen clinical outcomes in
aortic surgery.
Hemodilutional anemia increases organ
ischemia risk.
We show the lowest hematocrit (Hct) that
reduces transfusion and prevents hemodilution
associated complications.
Methods
We reviewed 399 cases of Ascending Aortic
(Aneurysm or Type A dissection) repair with
deep hypothermic circulatory arrest (DHCA).
Demographics and surgical characteristics
(except age) were similar between groups.
Patient ages were 17-89 and are grouped by Hct
<16%, <18%, 19%-20%, 21%-22%, > 23% at
temperature < 20C, 20-28C, 28-32C, 3234C, 34-35C during CPB.
Methods
Databases were established by collecting medical
information through patient medical records and 2010
ICD-9-CM Volume 1 Diagnosis Codes, including
complications of surgical and medical care, not
elsewhere classified 996-999 and diseases of the
specific system or organ.
The data analysis was by mean ( standard deviation) for
continuous variables and by frequency (percentage) for
qualitative variables. Two-sample t-test or Chi-Square
test was used to compare groups with P-value of less
than 0.05 considered significant.
Results
Changes in outcome were suggested at Hct <16%
versus >16% at <20C during DHCA and also for
Hct <18% versus>18% at temperature 20-28 C.
Risk of ARF and postoperative tracheotomy
increased with Hct < 16 (Table 2).
Chance of discharge home improved with higher
Hct at all temperatures (Table 3). Mortality
decreased at Hct 21-22% at 20-34C and increased
at Hct <16% during DHCA (Table 4).
Results
Results
Conclusion
Patient temperature affects oxygen demand, blood
viscosity, oxygen carrying capacity and delivery.
Hct value is a transfusion trigger and should change
with body temperature during aortic surgery.
Hct 21-22% appears favorable for CPB at 20-34C.
Hct <16% during DHCA increases mortality.
Hct <18% during rewarming (20-32C) increases
postoperative ARF risk.