Extensive Cell Salvage and Postoperative Outcomes Following Thoracoabdominal and Descending Aortic Repair

Abstract Objective Cell salvage reduces intraoperative blood transfusion. However, it may cause deformity of the red blood cells and loss of coagulation factors, which may lead to unwanted sequelae. Thus, we hypothesized the extensive cell salvage would lead to adverse outcomes after descending/thoracoabdominal aortic aneurysm (D/TAAA) repair. Methods Between 1991 and 2017, 2012 patients undergoing D/TAAA repair were retrospectively reviewed. After excluding patients without reported intraoperative cell salvage amount, patients were enrolled in the study (N=1474) and divided into two groups: low-cell salvage (Low-CS, salvaged units Results Preoperative demographics showed High-CS group had a significantly higher incidence of males (72% vs. 58%), heritable aortic disease (24% vs. 17%), redo (27% vs. 20%), higher glomerular filtration rate (mL/min/1.73m2, 75 vs. 66) and more extensive aneurysms (TAAA extent II-IV). High-CS group had significantly more postoperative complications compared to Low-CS group, including respiratory failure, renal failure, cardiac complications, neurological deficits, bleeding, and 30-day mortality. Multivariable analysis confirmed high cell salvage was an independent risk factor for renal failure along with long bypass time, older age, and extent of repairs. There was an incremental risk of renal failure and 30-day mortality proportional to salvaged cell unit (p Conclusions Increased salvaged cell unit was associated with adverse postoperative outcomes after D/TAAA repairs. Risk of renal failure and mortality increased proportionally to the salvaged cell units.