Abstract / Summary
Intraoperative albumin administration has been associated with increased bleeding and transfusion in on-pump cardiac surgery. However, albumin may also protect the endothelial glycocalyx and modulate inflammation during prolonged cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). Whether these potential benefits offset the risk of bleeding in total arch replacement (TAR) remains unclear. We aimed to examine the association between intraoperative albumin administration and perioperative red blood cell (RBC) transfusion in this population. This is a single-center, retrospective study. Adult patients undergoing TAR with DHCA from 2018 to 2024 were included. Patients were grouped according to intraoperative 20% albumin administration (200 mL vs. no albumin). Multivariable logistic regression, inverse probability of treatment weighting (IPTW), and overlap weighting (OW) were used to evaluate the association with perioperative RBC transfusion. A total of 1,381 patients were included, of whom 1,023 patients (74.1%) received albumin and 358 (25.9%) did not. Intraoperative albumin administration was associated with higher odds of perioperative RBC transfusion (adjusted odds ratio [OR], 1.80; 95% confidence interval [CI], 1.33–2.45; P < 0.001). This result remained significant in IPTW and OW analyses (OR, 1.75; 95% CI, 1.36–2.26; P < 0.001 for IPTW; OR, 1.77; 95% CI, 1.38–2.27; P < 0.001 for OW). Moreover, postoperative chest tube drainage was greater in the albumin group. No significant differences were observed in AKI, in-hospital mortality, reoperation for bleeding, or other major postoperative complications. In patients undergoing TAR, intraoperative 20% albumin administration was associated with higher odds of perioperative RBC transfusion, while no significant differences were observed in major postoperative adverse events. These findings suggest that routine intraoperative use of 20% albumin may not provide clear clinical benefit in this high-risk population. Given the observational design and the potential for residual confounding, these findings should be interpreted with caution. not applicable.