BACKGROUND Some observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoingcardiac surgery may be especially vulnerable to the adverse effects of transfusion. METHODS We conducted a randomized trial at multiple sites from 2010 to 2014. Participants 12 years of age or older who were undergoing complex cardiac surgery and were likely to undergo transfusion of red cells were randomly assigned to receive leukocyte-reduced red cells stored for 10 days or less (shorter-term storage group) or for 21 days or more (longer-term storage group) for all intraoperative and postoperative transfusions. The primary outcome was the change in Multiple Organ Dysfunction Score (MODS; range, 0 to 24, with higher scores indicating more severe organ dysfunction) from the preoperative score to the highest composite score through day 7 or the time of death or discharge. RESULTS The median storage time of red-cell units provided to the 1098 participants who received red-cell transfusion was 7 days in the shorter-term storage group and 28 days in the longer-term storage group. The mean change in MODS was an increase of 8.5 and 8.7 points, respectively (95% confidence interval for the difference, −0.6 to 0.3; P = 0.44). The 7-day mortality was 2.8% in the shorter-term storage group and 2.0% in the longer-term storage group (P = 0.43); 28-day mortality was 4.4% and 5.3%, respectively (P = 0.57). Adverse events did not differ significantly between groups except that hyperbilirubinemia was more common in the longer-term storage group. CONCLUSIONS The duration of red-cell storage was not associated with significant differences in the change in MODS. We did not find that the transfusion of red cells stored for 10 days or less was superior to the transfusion of red cells stored for 21 days or more among patients 12 years of age or older who were undergoing complex cardiac surgery. (Funded by the National Heart, Lung, and Blood Institute; RECESS ClinicalTrials.gov number, NCT00991341.)

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An obese 82-year-old woman with a history of hypertension and type 2 diabetes mellitus had had dyspnea on exertion and swelling of her legs for three to four months. Transthoracic echocardiography revealed a right atrial mass with extension into the inferior vena cava. Computed tomography of the chest and abdomen showed that the mass originated in the left kidney. The results of coronary angiography, ventilation-perfusion scanning, and bone scanning were normal. A radical left nephrectomy and excision of the right atrial mass were performed with the use of cardiopulmonary bypass. Intraoperative two-dimensional transesophageal echocardiography with an omniplane probe (Panel A) revealed a mass (T) in the right atrium (RA) that prolapsed into the right ventricle (RV) during diastole, mild-to-moderate tricuspid regurgitation, and a normal aorta (A), pulmonic valve (PV), and pulmonary artery (PA). The patient tolerated the surgery well and was discharged home on the 10th postoperative day. The mass was a renal-cell carcinoma measuring 17 by 3 by 2 cm (Panel B).

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