Aortic Valve Prosthesis and Transfusion Strategy
Purpose. Investigation of transfusion strategies during surgery and in the postoperative period in patients with aortic valve replacement (AVR). Materials and methods. Retrograde study of transfusion strategies in 81 patients after AVR was performed. All patients were divided into 3 groups depending on the use of transfusion strategies. Group 1 (27 patients) is characterized by liberal (arbitrary) transfusion strategy (LTS) with transfusion of donated blood components. Group 2 (38 patients) is characterized by restrictive (saving) transfusion strategy (RTS) with transfusion of donated blood components. Group 3 (16 patients) was operated by blood-sparing transfusion strategy (BTS) using the patient’s autologous blood without transfusion of donated blood components. The study has 3 stages: stage 1 included aortic valve replacement (AVR), stage 2 - treatment in the resuscitation department, stage 3 - treatment in the intensive therapy room. Results. During AVR procedure and in the postoperative period, the volume of donated blood components (DBC) in the LTS group was 8.9 times higher (p<0.05) than the volume of transfusions in the BTS group. At all stages of the surgery and the postoperative period in RTS group the volume of DBC was 6.1 times (p<0.05) higher than in BTS group. In BTS group, the reinfused autologous blood of the patients was used during the surgery. In BTS group, the transfusions of DBC in resuscitation department and intensive therapy room were minimal. Conclusion. At all stages of studying the total volume of pRBCs (packed red blood cells) transfused in LTS group was 10.6 times (p<0.05), and in RTS group was 7.6 times (p<0.05) higher than in BTS group. The total volume of native fresh frozen plasma in LTS group was 6.0 times (p<0.05), and in RTS group was 4.1 times (p<0.05) higher than in BTS group. At all stages, the volume of platelet concentrate transfusions in LTS group was 7.6 times (p<0.05), and in RTS group was 2.9 times (p<0.05) higher than in BTS group. The decrease in the fibrinogen levels and prothrombin index in RTS and BTS groups during surgery stage does not lead to an increase in exudative losses and DBC transfusions in the postoperative period.