M. Eldeiry1, M. Aftab1, J. Pal1, J. C. Cleveland1, D. Fullerton1, T. B. Reece1 1University of Colorado,Cardiothoracic Surgery / General Surgery / School Of Medicine,Aurora, CO, USA
Introduction: Hypothermic circulatory arrest (HCA) with antegrade cerebral perfusion has allowed an evolution in the nadir temperature for proximal arch replacement. Colder temperature provides neuronal protection but also compounds coagulopathy following bypass. We hypothesized that nadir temperatures during circulatory arrest (CA) can predict the need for post-operative transfusions in hemiarch replacements.
Methods: Data on hemiarch replacements from 2009 – 2018 was analyzed at a single institution. Univariate logistic regressions were performed on post-operative red blood cell (RBC) transfusions and factor (platelet, plasma, cryoprecipitate) transfusions as a function of 22 variables. These included age, gender, co-morbidities, baseline lab measurements, operative times, and nadir temperature during HCA. Multivariate logistic models were subsequently generated using the variables with significant odds ratio (OR, p < 0.05) in the univariate analysis.
Results: A total of 282 cases were performed. Out of 10 significant variables, lower baseline hemoglobin (Hgb) and creatinine clearance (Cr Cl), female gender, and redo status were associated with higher odds of requiring a RBC transfusion (Table). Nadir Temperatures ranged from 18-30 °C and, along with female status, were the only variables correlating to factor transfusions (Table). In a post-hoc analysis, nadir temperatures were not associated with a difference in neurologic outcomes (p = 0.66).
Conclusions: Overall, female patients tended to require more transfusions. The correlation for factor transfusions were interestingly associated strongly to nadir temperatures during HCA with 26% drop in odds of requiring a factor transfusion for each 1 °C increase in temperature. Furthermore, lack of difference in neurologic outcomes with nadir temperatures suggests that increasing the temperature during HCA maybe safe and potentially advantageous.
