Blood management with preoperative autologous blood in valve-sparing root replacement: separated autologous red blood cells and plasma and fibrin sealant versus autologous whole blood.

OBJECTIVES

We investigated the effects of the combined use of preoperatively separated autologous red blood cells, plasma, and fibrin sealant on reducing allogeneic blood transfusion during valve-sparing root replacement using the aortic root remodeling technique, by comparison with transfusion of refrigerated, predeposited autologous whole blood.

METHODS

Thirty-nine patients underwent elective, initial valve-sparing root replacement using the aortic root remodeling technique by a single surgeon between April 2018 and December 2023. Of these, 9 patients in Group A predeposited autologous whole blood until September 2019 and 12 patients in Group B predeposited separated autologous red blood cells, plasma, and fibrin sealant after October 2019. The intraoperative allogeneic blood transfusion avoidance rate was compared between Groups A and B.

RESULTS

The allogeneic blood transfusion avoidance rate in Group A was 66.7% for red blood cells, 55.6% for plasma, 55.6% for platelets, and 55.6% for all components combined. In Group B, the avoidance rate was 100% for each component, significantly higher than in Group A for plasma, platelets, and all components combined (all P = 0.021). Postoperative hemoglobin level was significantly higher and amount of chest tube drainage during the first 12 postoperative hours was lower in Group B.

CONCLUSIONS

This before-and-after study suggested that the combined use of preoperatively separated autologous red blood cells and plasma and fibrin sealant can be an effective blood management strategy in patients undergoing valve-sparing root replacement using the aortic root remodeling technique, reducing intraoperative allogeneic blood transfusion compared with predeposited autologous whole blood transfusion.