Prevention and approaches to bleeding control during ascending aorta replacement

Introduction. Bleeding is an extremely urgent problem in aortic surgery, where its frequency and significance are greater than in other cardiac operations. Among the measures to prevent bleeding, surgical technique plays a fundamental role, especially the methods of forming the anastomosis with the aorta to ensure its tightness. The scientific literature presents many technical modifications of aortic anastomoses, but there are currently no large comparative studies with a high degree of evidence.

The objective of this study was to evaluate the efficiency of the protocol of intraoperative support and control of surgical hemostasis, which describes the principles of surgical technique when performing interventions on the aorta, the technique of forming anastomoses and methods of staged control of hemostasis stability during ascending aorta replacement.

Methods and materials. Patients who underwent ascending aorta replacement were divided into two groups. The group where the above protocol was used (n=24) and the group with the standard surgical technique (n=19). These groups were compared with each other by the following parameters: bleeding frequency, blood loss volume, frequency of resternotomies, volume of transfused blood components, treatment duration, complication and mortality rate.

Results. Statistically significant differences (p<0.05) were obtained in the volume of intra- and postoperative blood loss, as well as in the frequency of all postoperative bleeding and bleeding requiring resternotomy. Statistically significant differences were also obtained in the volume of transfusion of erythrocyte-containing blood components, fresh frozen plasma and cryoprecipitate. It was found that patients from the first group had a shorter stay in the intensive care unit and a shorter postoperative stay. There were no statistically significant differences in complication and mortality rate in the available patient sample.

Conclusions. The protocol of intraoperative support and control of surgical hemostasis is an effective approach to prevent bleeding during ascending aorta replacement.

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