Intraoperative platelet transfusion is associated with increased postoperative sternal wound infections among type A aortic dissection patients after total arch replacement

Background: Blood transfusion and its impact upon clinical outcomes of cardiac surgery have been extensively discussed, especially in the post-aprotinin era. This study compared clinical outcomes and perioperative blood utilisation among acute type A aortic dissection (AAD) patients with or without intraoperative platelet transfusion during total arch replacement, thus intending to investigate prognostic value of platelet transfusion during major aortic surgeries.

Materials and methods: Acute AAD patients undergoing total arch replacement and stented elephant trunk procedure under hypothermic circulatory arrest with and without intraoperative platelet transfusion at our institute from January 2008 to December 2012 were retrospectively included. Patients were categorised into PLT (n = 74) and non-PLT (n = 85) groups to compare the in-hospital mortality and complications, as well as blood components utilisation.

Results: Baseline characteristics and operational features were all comparable between two groups. In PLT group, in-hospital survival was not improved and intraoperative utilisation of red blood cell RBC, fresh frozen plasma (FFP) and cryoprecipitate was not reduced. Postoperative RBC transfusion [2.0(0-4.0) vs 0(0-4.0) U, p = 0.026; 64.9 vs 43.5%, p = 0.007] was significantly increased in PLT group, parallel with the prolonged postoperative hospitalisation time [(24.0 ± 12.7) vs (20.8 ± 10.9) days, p = 0.093] and elevated incidence of sternal wound infections (16.2 vs 5.9%, p = 0.035). Intraoperative platelet transfusion [odds ratio (OR): 3.10, 95% confidence interval (CI): 1.04-9.25, p = 0.043] was identified as independent risk factor of postoperative sternal wound infections by multivariate logistic regression analysis.

Conclusion: Intraoperative platelet transfusion did not improve in-hospital prognosis among AAD patients after total arch replacement. The incidence of postoperative sternal wound infections increased among those who received intraoperative platelet transfusion.