Blood loss as the main cause of organ dysfunction after simultaneous ascending aorta and aortic arch replacement

Objective. To study the effect of intraoperative blood loss on postoperative outcomes in patients with aneurysm and/or dissection of ascending aorta and aortic arch. Material and methods. A retrospective analysis included 77 patients (mean age 52.8±11.4 years). All ones underwent ascending aorta and aortic arch replacement under cardiopulmonary bypass and antegrade cerebral perfusion with hypothermia (mean 23.9±3.2 °C) for aneurysm and/or dissection. To identify the relationship between blood loss and incidence of organ dysfunctions, we used the original parameter, i.e. blood loss index (intraoperative blood loss / weight / surgery time) (ml/kg/hour). Results. There was a significant correlation between blood loss index and postoperative organ dysfunctions (r=0.57, p<0.001). At the same time, we found no correlation between overall blood loss and postoperative organ dysfunctions (r=0.23, p=0.23). According to the ROC curve, the cut-off values were 2.9 ml/kg/hour for respiratory failure, 3.1 ml/kg/hour for cardiovascular failure and 6 ml/kg/hour for multiple organ failure. Sensitivity of each point was 72%, 81% and 84%, specificity 59%, 59% and 64%, respectively. Conclusion. Blood loss index is valuable to predict organ dysfunctions after ascending aorta and aortic arch surgery. The conditionally «safe» blood loss index is less than 3 ml/kg/hour.