Blood Transfusion Predicts Prolonged Mechanical Ventilation in Acute Stanford Type A Aortic Dissection Undergoing Total Aortic Arch Replacement

BACKGROUND: This research aimed to evaluate the impacts of transfusing packed red blood cells (pRBCs), fresh frozen plasma (FFP), or platelet concentrate (PC) on postoperative mechanical ventilation time (MVT) in patients with acute Stanford type A aortic dissection (ATAAD) undergoing after total arch replacement (TAR). METHODS: The clinical data of 384 patients with ATAAD after TAR were retrospectively collected from December 2015 to October 2017 to verify whether pRBCs, FFP, or PC transfusion volumes were associated with postoperative MVT. The logistic regression was used to assess whether blood products were risk factors for prolonged mechanical ventilation (PMV) in all three endpoints (PMV ≥24 h, ≥48 h, and ≥72 h). RESULTS: The mean age of 384 patients was 47.6 ± 10.689 years, and 301 (78.39%) patients were men. Median MVT was 29.5 (4–574) h (h), and 213 (55.47%), 136 (35.42%), and 96 (25.00%) patients had PMV ≥24 h, ≥48 h, and ≥72 h, respectively. A total of 36 (9.38%) patients did not have any blood product transfusion, the number of patients with transfusion of pRBCs, FFP, and PC were 334 (86.98%), 286 (74.48%), and 189 (49.22%), respectively. According to the multivariate logistic regression of three PMV time-endpoints, age was a risk factor [PMV ≥ 24 h odds ratio (OR(PMV≥24)) = 1.045, p = 0.005; OR(PMV≥48) = 1.060, p = 0.002; OR(PMV≥72) = 1.051, p = 0.011]. pRBC transfusion (OR(PMV≥24) = 1.156, p = 0.001; OR(PMV≥48) = 1.156, p < 0.001; OR(PMV≥72) = 1.135, p ≤ 0.001) and PC transfusion (OR(PMV≥24) = 1.366, p = 0.029; OR(PMV≥48) = 1.226, p = 0.030; OR(PMV≥72) = 1.229, p = 0.011) were independent risk factors for PMV. FFP had no noticeable effect on PMV [OR(PMV≥48) = 0.999, 95% confidence interval (CI) 0.998–1.000, p = 0.039; OR(PMV≥72) = 0.999, 95% CI: 0.998–1.000, p = 0.025]. CONCLUSIONS: In patients with ATAAD after TAR, the incidence of PMV was very high. Blood products transfusion was closely related to postoperative mechanical ventilation time. pRBC and PC transfusions and age increased the incidence of PMV at all three endpoints.