Abstract
BACKGROUND: In thoracic aortic surgery, a large amount of blood transfusion is required because of preoperative coagulopathy and long cardiopulmonary bypass (CPB) time. This study aimed to investigate the efficacy of intraoperative thromboelastography (TEG)-guided blood transfusion management in thoracic aortic surgery. METHODS: Between 2015 and 2017 at our institution, 53 patients who underwent elective thoracic aortic surgery with hypothermic circulatory arrest through median sternotomy were divided into 2 groups: group C, conventional management (25 patients); and group T, TEG-guided management (28 patients). In group T, TEG was measured twice, before and after CPB. In both groups, red blood cells (RBCs) were transfused to maintain hemoglobin levels >10 g/dL during surgery and >8 g/dL during CPB. Fresh frozen plasma (FFP) was transfused even during CPB to correct coagulant disorder before CPB was off. The ratio of RBC/FFP was 1:1 in group C and 1:2 in group T if pre-CPB citrated functional fibrinogen-maximum amplitude (CFF-MA) was ≤20 mm. Additional FFP was transfused if the value of post-CPB CFF-MA was ≤14 mm. RESULTS: The amounts of postoperative bleeding, post-CPB RBC transfusion, postoperative RBC transfusion, and postoperative FFP transfusion were significantly lower in group T than in group C (P = .025, .042, .042, and .020, respectively). However, there was no impact on early and midterm survival of patients. CONCLUSIONS: These results suggest that intraoperative TEG-guided blood transfusion management in thoracic aortic surgery is effective in reducing postoperative bleeding and the amount of blood transfusion.