Pre-pump Autologous Blood Collection Is Associated With Reduced Intraoperative Transfusions In Aortic Surgery With Circulatory Arrest: A Propensity-matched Analysis

Abstract Objective To evaluate the effect of autologous whole blood (AWB) collection on intraoperative/postoperative allogeneic blood transfusion rate in complex aortic surgery with hypothermic circulatory arrest (HCA). Methods This retrospective study included adults who underwent aortic surgery with HCA at a single institution between 2014 and 2019. Out of 509 cases (414 patients), 110 (22%) received the AWB protocol. We performed propensity-score matching, including 35 preoperative and procedural variables, which resulted in 95 well-matched pairs, to compare outcomes in patients who received AWB protocol versus those who did not. Study outcomes were percentage of patients who received transfusion of allogeneic blood products intraoperatively and postoperatively. Results Mean volume of collected autologous blood was 826±263 mL. Intraoperatively, fewer AWB patients received red blood cell (RBC) concentrate (33% vs 49%; p=.02), plasma (35% vs 62%; p=.0002), platelets (61% vs 81%; p=.003), and cryoprecipitate (43% vs 56%; p=.08) compared with non-AWB patients. During the entire hospital stay, the differences in transfusion rate between the two groups were: RBC (58% vs 62%; p=.6), plasma (49% vs 66%; p=.01), platelets (72% vs 82%; p=.09) and cryoprecipitate (56% vs 63%; p=.3). Conclusions Pre-pump autologous blood collection may reduce the need for intraoperative transfusion of allogenic non-red cell blood products in patients undergoing complex aortic surgery with hypothermic circulatory arrest. A larger study is needed to clarify the impact of this association on patient outcomes and resource utilization.