Anemia in Cardiac Surgery — Can Something Bad Get Worse?

Abstract

Introduction Anemia and blood transfusion are risk factors for morbidity/mortality in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The objective of this study is to analyze the association of blood transfusion with morbidity/mortality in patients undergoing coronary artery bypass grafting (CABG) under CPB in the state of São Paulo, Brazil. Methods This is a retrospective analysis using the State of São Paulo Registry of Cardiovascular Surgery from November 2013 to August 2014. Blood transfusion was only considered during surgery or within six hours after surgery. Anemia was defined as hematocrit ≤ 37.5%. Patients < 18 years old were excluded. The sample was divided in four groups - Group I (851, no anemia), Group II (200, anemia without blood transfusion), Group III (181, no anemia and transfusion), and Group IV (258, anemia and transfusion). Results A total of 1,490 patients were included; 639 (42.9%) were anemic and 439 (29.5%) underwent blood transfusion. Group II showed lower composite morbidity (odds ratio [OR] −0.05; confidence interval [CI] −0.27-0.17; P =0.81) than Group III (OR 0.41; CI 0.23-0.59; P =0.018) or Group IV (OR 0.54; CI 0.31-0.77; P =0.016). Group III was at greater risk of mortality (OR 0.73; CI 0.43-1.03; P =0.02) than Group II, which was exposed only to anemia (OR −0.13; CI −0.55-0.29; P =0.75), or Group IV (OR 0.29; CI −0.13-0.71; P =0.539). Conclusion Anemia in patients undergoing CABG with CPB is bad, but blood transfusion can be worse, increasing at least 50% the risk for mortality and/or morbidity.

A Comprehensive Patient Blood Management Program During Cardiopulmonary Bypass in Patients Over 60 Years of Age

“…Anemia has been linked to unfavorable outcomes such as mortality, acute kidney injury, and respiratory insufficiency. [2][3][4] However, it is important to note that blood transfusion itself can pose risks for postoperative adverse events. 5,6 Consequently, it becomes crucial to strike a balance between managing anemia and determining an appropriate transfusion threshold specifically for older adults.…”

Use of Different Cardioplegia Solutions in Heart Valve Surgery

“…The number of patients receiving blood transfusion was found to be significantly higher in the Custodiol® group ( P =0.024). We believe that it would be beneficial to clearly state the patients’ preoperative hemoglobin values, autologous prime status in cardiopulmonary bypass systems, and blood transfusion indications when evaluating the necessity of blood transfusion [ 7 , 8 ] . It may also be better to use this variable as a numeric variable.…”