Successful surgical repair of acute type A aortic dissection without the use of blood products

Area of Science:

• Cardiovascular Surgery
• Cardiology
• Transfusion Medicine

Background:

• Type A aortic dissection repair presents challenges, especially for patients refusing blood transfusions.
• Jehovah's Witnesses require alternative strategies due to their objection to allogeneic blood products.
• Aortic dissection is associated with a high risk of bleeding and coagulopathy, complicating surgical management.

Purpose of the Study:

• To report the successful surgical treatment of type A aortic dissection in a Jehovah's Witness without blood product transfusion.
• To highlight the feasibility of aortic dissection repair using advanced blood conservation strategies.

Main Methods:

• Interposition graft replacement of the ascending aorta under cardiopulmonary bypass with antegrade cerebral perfusion.
• Utilized cell salvage and preoperative hemodilution for autologous transfusion.
• Administered tranexamic acid, desmopressin, recombinant factor VIIa, folic acid, and epoetin alfa.
• Maintained minimal hypothermia (32°C) to preserve platelet function.

Main Results:

• Successful surgical repair of type A aortic dissection was achieved without the need for blood products.
• The patient tolerated the procedure well, with effective blood conservation strategies employed.
• No significant coagulopathy or bleeding complications were reported post-operatively.

Conclusions:

• Surgical repair of type A aortic dissection is achievable in patients refusing blood products.
• A combination of cell salvage, pharmacologic agents, and minimal hypothermia is crucial for successful outcomes.
• This approach offers a viable alternative for Jehovah's Witnesses undergoing complex aortic surgery.