The Impact Of Minimally Invasive Techniques On Patient Blood Management Programs In Aortic Valve Surgery
Serdar Gunaydin1, Kevin McCusker2.
1Numune Training & Research Hospital, Ankara, Turkey, 2New York Medical College, New York, NY, USA.
Objective:The implementation of a multidisciplinary patient blood management (PBM) program may contribute to a reduction in transfusion requirements, a decrease in health costs and an improvement in patient outcomes. We compared two different time intervals of aortic valve replacement (via conventional and minimally invasive techniques) under different strategies of blood management. Methods: This retrospective cohort study included high-risk patients (Euroscore II >5) undergoing aortic valve surgery under different PBM strategies during the period from January 2011 until November 2018 (Table below). Patients were matched for age, gender, BMI and STS score: Group 1(control): (2011-2014) N=294 and Group 2: (2015-2018) N=277. Results: The percentage of patients received transfusion was 14.3% in Group 2 and 34.6% in control (p<0.05). Postoperative hemorrhage (Group 2: 220 ± 30 and 775 ± 60 mL in control; p=0.012), respiratory support duration (8.3 ± 2 /16.7 ± 2 h- p=0.011) and ICU stay (1.03±1 vs 2.6±1.1 days, p=0.025) were significantly better in the Group 2 vs control. No difference in mortality and major complications were noted. Stepwise multiple logistic regression analysis demonstrated minimally invasive surgery (OR:5.1), minimally invasive extracorporeal circuitry (OR:3.66) and cardioplegia type (OR:3.2) as leading independent predictors of the reduction in transfusion. Cost analysis demonstrated 11.9% decrease in Group 2 with respect to Group 1(p=0.035).Conclusions:
Based on available evidence, PBM protocols are likely to be most productive for high-risk cardiac patients. The extent is in significant progress introducing minimally invasive techniques and circulation. Studies with higher patient population is still warranted. LEGEND: Components of Patient Blood Management Strategies Within Years
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