Two-staged aortic repair for acute type A aortic dissection in patients refusing blood transfusion.

Background: It is still challenging to perform high-risk cases, such as acute type A dissection, which frequently require blood transfusions. We created perioperative bloodless protocol, but it includes an optimization to increase the preoperative hemoglobin level enough to tolerate cardiopulmonary bypass. However, it would be impossible to optimize such patients using the strategy in the setting of emergent surgery. We sought to create a surgical strategy in an effort to reduce blood loss for acute type A dissection patients refusing blood transfusion.

Methods: We reviewed the records of two patients in our aortic surgery database who presented with acute aortic dissection and refused blood transfusion. These patients underwent two-staged aortic repair with ascending aortic replacement with debranching to the innominate and left common carotid arteries, followed by thoracic endovascular aortic repair (TEVAR).

Results: : The two-staged procedure was successfully completed in two patients without any significant complication. The postoperative course was uneventful for both patients.

Conclusion: Two-staged aortic repair in patients refusing blood transfusion can avoid circulatory arrest requiring deep hypothermia so as to reduce the risk of coagulopathy and blood loss.