Red Blood Cell Transfusion and Cardiopulmonary Bypass Duration as Predictors of In-Hospital Mortality in Emergency Aortic Dissection Surgery

Objectives: Aortic dissection (AD) is a life-threatening condition requiring urgent intervention. Despite advances in anesthetic and perioperative management, surgical outcomes remain poor. Anesthesiologists play a critical role in managing hemodynamics, blood loss, and transfusions. This study aimed to share our experience in emergency AD surgery and identify factors associated with in-hospital mortality.
Methods: This retrospective study included 51 patients who underwent surgery for acute DeBakey type I or II AD. Clinical and perioperative data were obtained from hospital records.
Results: The mean age was 59.7±12.6 years, and 60.8% of the patients were male. Type I dissection was present in 82.4% of patients. The median anesthesia duration was 255 minutes. Packed red blood cell (PRBC) transfusions were administered to 70.6% of patients. In-hospital mortality occurred in 33.3% of cases. Non-survivors had longer cardiopulmonary bypass (CPB) times (p=0.014) and received more PRBC units (p=0.018). A significant correlation was observed between PRBC transfusion and total circulatory arrest duration (r=0.335, p=0.034). In multivariate analysis, both PRBC transfusion (OR: 2.10, 95% CI: 1.03–4.29, p=0.042) and CPB duration (OR: 1.03, 95% CI: 1.01–1.05, p=0.007) were identified as independent predictors of in-hospital mortality.
Conclusion: The number of PRBC units transfused and CPB duration were independent predictors of mortality in emergency AD surgery. PRBC transfusions were also correlated with circulatory arrest duration. These findings highlight the importance of careful transfusion management in this high-risk population.

Keywords: Aortic dissection, cardiopulmonary bypass, erythrocyte transfusion, hospital mortality, hypothermia, induced, risk factors