Background-Red blood cell transfusion can both benefit and harm. To inform decisions about transfusion, we aimed to quantify associations of transfusion with clinical outcomes and cost in patients having cardiac surgery. Methods and Results-Clinical, hematology, and blood transfusion databases were linked with the UK population register.Additional hematocrit information was obtained from intensive care unit charts. Composite infection (respiratory or wound infection or septicemia) and ischemic outcomes (myocardial infarction, stroke, renal impairment, or failure) were prespecified as coprimary end points. Secondary outcomes were resource use, cost, and survival. Associations were estimated by regression modeling with adjustment for potential confounding.

Current general restrictions on the use of colloid solutions are not supported by evidence.

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In our registry, treatment with aprotinin is recorded as "in theater" or subsequently. Aprotonin treatment (none, in theater, or subsequently) was included in the propensity model, although the frequencies of patients given aprotinin (9% in theater, 1% subsequently) were not reported. 1 New analyses, explicitly including aprotinin treatment (in addition to nadir hematocrit stratum and propensity score deciles), show that the propensity score controlled well for confounding by aprotinin; odds ratios (ORs) for composite infection and ischemic outcomes given transfusion were 3.31 (95% confidence interval, 2.59 to 4.24, estimated by bootstrapping) and 3.29 (95% confidence interval, 2.59 to 4.26), respectively, compared with 3.38 and 3.35 without aprotinin explicitly included in the models.

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The prevalence of coronary artery anomalies is approximately 0.6% in individuals undergoing angiography. Most of the anomalies are benign, but some can lead to myocardial infarction, cardiomyopathy, and sudden cardiac death. It is very rare to have an entire coronary circulation that arises from the right coronary cusp. We present a case of a 57-year-old male who presented with complaints of chest pain and dyspnea on exertion. An invasive angiogram revealed all the three coronary arteries originating from the right coronary cusp. It is crucial to define coronary anatomy as anomalies dictate which cardiac intervention should be attempted in cases of ischemia.

An anomalous origin of the right coronary artery is usually asymptomatic. It is mostly found incidentally on an invasive diagnostic angiogram. It does lead to an increased risk of sudden cardiac death, especially in younger patients. We present a case of a 41-year-old who had presented to the hospital with complaints of chest pain. The patient was evaluated by cardiology who performed an angiography that identified an anomalous origin of the right coronary artery arising from the left coronary cusp but no evidence of coronary artery disease. Once identified, these anomalous vessels should be corrected surgically, as these conditions increase the risk of sudden cardiac death arrhythmia and ischemic events.