Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery

Kuduvalli, Manoj; Oo, Aung; Newall, Nick; Grayson, Antony D.; Jackson, Mark; Desmond, Michael; Fabri, Brian M.; Rashid, Abbas

doi:10.1016/j.ejcts.2005.01.030

Cited by 250 publications

(161 citation statements)

References 23 publications

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“…Several studies have assessed the relationship between RBC transfusion and outcome, not accounting for the duration of storage of the blood. For example, an association was found between perioperative RBC transfusion and long-term mortality after coronary artery bypass graft surgery (7,8). Consistent with these studies, among 24,112 patients with acute coronary syndrome, those who received a RBC transfusion had a significantly higher unadjusted rate of 30-day death (8.00% vs. 3.08%; P Ͻ 0.001) (9).…”

Section: H) P Values Represent Comparison Between Values In Rbcs Asssupporting

confidence: 72%

“…Thus, the time courses of individual functional changes differ markedly from one another. Recent studies suggest that these changes may be clinically relevant, and further study is needed to determine how these changes relate to the excess morbidity and mortality associated with transfusion (7)(8)(9)12). In addition, we confirm numerous biochemical and functional changes previously reported during RBC storage, including some changes that may be related to our findings.…”

Section: H) P Values Represent Comparison Between Values In Rbcs Assmentioning

confidence: 99%

“…The storage-related deficiency of SNO-Hb and impairments in RBC vasoactivity and deformability (38, 54) may disrupt normal O 2 delivery (a function of both blood flow and O 2 offloading) by RBCs in the microcirculation, predisposing to the excess morbidity and mortality associated with RBC transfusion in some patient groups (7)(8)(9)12). Strategies to replenish SNOs in RBCs have been shown in other diseases to be effective and partially reverse the related impairment in RBC-dependent vasodilation and correlated physiologic derangements (28,30).…”

Section: H) P Values Represent Comparison Between Values In Rbcs Assmentioning

confidence: 99%

“…Despite these observational data, no large controlled clinical trials have been conducted to evaluate the relationship between the age of stored RBCs and clinical outcomes. RBC-transfused patients had worse outcomes than nontransfused patients matched for clinical variables in several studies (6)(7)(8)(9)(10). Moreover, in randomized clinical trials, a more liberal RBC transfusion strategy failed to benefit pediatric or adult patients with anemia and critical illness (11,12), raising the broader concern that RBC storage is problematic (2,13) and could be improved.…”

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confidence: 99%

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Evolution of adverse changes in stored RBCs

Bennett‐Guerrero¹,

Veldman²,

Doctor

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

539

556

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Recent studies have underscored questions about the balance of risk and benefit of RBC transfusion. A better understanding of the nature and timing of molecular and functional changes in stored RBCs may provide strategies to improve the balance of benefit and risk of RBC transfusion. We analyzed changes occurring during RBC storage focusing on RBC deformability, RBC-dependent vasoregulatory function, and S-nitrosohemoglobin (SNO-Hb), through which hemoglobin (Hb) O2 desaturation is coupled to regional increases in blood flow in vivo (hypoxic vasodilation). Five hundred ml of blood from each of 15 healthy volunteers was processed into leukofiltered, additive solution 3-exposed RBCs and stored at 1-6°C according to AABB standards. Blood was subjected to 26 assays at 0, 3, 8, 24 and 96 h, and at 1, 2, 3, 4, and 6 weeks. RBC SNO-Hb decreased rapidly (1.2 ؋ 10 ؊4 at 3 h vs. 6.5 ؋ 10 ؊4 (fresh) mol S-nitrosothiol (SNO)/mol Hb tetramer (P ‫؍‬ 0.032, mercuric-displaced photolysis-chemiluminescence assay), and remained low over the 42-day period. The decline was corroborated by using the carbon monoxide-saturated copper-cysteine assay [3.0 ؋ 10 ؊5 at 3 h vs. 9.0 ؋ 10 ؊5 (fresh) mol SNO/mol Hb]. In parallel, vasodilation by stored RBCs was significantly depressed. RBC deformability assayed at a physiological shear stress decreased gradually over the 42-day period (P < 0.001). Time courses vary for several storage-induced defects that might account for recent observations linking blood transfusion with adverse outcomes. Of clinical concern is that SNO levels, and their physiological correlate, RBC-dependent vasodilation, become depressed soon after collection, suggesting that even ''fresh'' blood may have developed adverse biological characteristics.adenosine triphosphate ͉ hemoglobin ͉ nitric oxide ͉ S-nitrosothiols ͉ transfusion

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Section: H) P Values Represent Comparison Between Values In Rbcs Asssupporting

confidence: 72%

Section: H) P Values Represent Comparison Between Values In Rbcs Assmentioning

confidence: 99%

Section: H) P Values Represent Comparison Between Values In Rbcs Assmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Evolution of adverse changes in stored RBCs

Bennett‐Guerrero¹,

Veldman²,

Doctor

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

539

556

View full text Add to dashboard Cite

show abstract

“…[1][2][3] Although transfusion can be lifesaving in some clinical scenarios, most observational studies have shown a clear relationship between transfusion and adverse outcomes. [4][5][6][7] In prospective clinical trials that have compared liberal to restrictive transfusion strategies, the findings have revealed either no benefit [8][9][10][11][12] or increased morbidity and mortality 13 associated with increased use of transfusions.…”

Section: Introductionmentioning

confidence: 99%

Impaired Red Blood Cell Deformability After Transfusion of Stored Allogeneic Blood But Not Autologous Salvaged Blood in Cardiac Surgery Patients

Salaria

Barodka

Hogue

et al. 2015

Survey of Anesthesiology

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Background-Both cardiopulmonary bypass (CPB) and red blood cell (RBC) storage are associated with detrimental changes in RBC structure and function that may adversely affect tissue oxygen delivery. We tested the hypothesis that in cardiac surgery patients, RBC deformability and aggregation are minimally affected by CPB with autologous salvaged blood alone, but are negatively affected by the addition of stored allogeneic blood.

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Variation in Use of Blood Transfusion in Coronary Artery Bypass Graft Surgery

Bennett‐Guerrero¹,

Zhao²,

O’Brien³

et al. 2010

JAMA

436

331

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ATIENTS WHO UNDERGO CARdiac surgery receive a significant proportion of the 14 million units of allogeneic red blood cells (RBCs) transfused annually in the United States. 1 Numerous observational studies in patients who underwent cardiac surgery have shown an association between RBC transfusion and adverse outcome, including morbidity, mortality, resource utilization, and quality of life. [2][3][4][5][6][7][8][9] To date, no large randomized trials of transfusion thresholds have been conducted in cardiac surgery to our knowledge to address this issue.Almost 20 years ago, the study by Goodnough et al 10 demonstrated that there was significant practice variability in transfusion practices at 18 US centers. However, this study and subsequent studies [11][12][13][14] were limited in size and did not adjust for hospital or patient factors. Since these earlier studies, the Society of Thoracic Surgeons (STS) and Society of Cardiovascular Anesthesiologists published transfusion recommendations in 2007. 15 However, the degree to which guidelines have resulted in consensus in community transfusion practice is unknown. Therefore, the primary goal of our study was to assess use of RBC, fresh-frozen plasma, and platelet transfusions in coronary artery bypass graft (CABG) surgery in contemporary practice. Our analyses specifically addressed the degree to which transfusion practices varied among US hospitals, after adjusting for patient characteristics. METHODS Data SourceThe STS Adult Cardiac Surgery Database (ACSD) was established in 1989 to report outcomes following cardiothoracic surgical procedures. [16][17][18][19][20] The database captures clinical information from the majority of US cardiac surgical procedures. A recent analysis demon-strated that more than 80% of patients undergoing CABG operations in the United States in 2007 were represented in the STS database. 21 Sites enter patient data using uniform definitions

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Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery

Abstract: Peri-operative RBC transfusion after CABG is associated with an increased risk of mortality during a 1-year follow-up period, with a large proportion of deaths occurring within 30-days.

Cited by 250 publications

References 23 publications

Evolution of adverse changes in stored RBCs

Evolution of adverse changes in stored RBCs

Impaired Red Blood Cell Deformability After Transfusion of Stored Allogeneic Blood But Not Autologous Salvaged Blood in Cardiac Surgery Patients

Variation in Use of Blood Transfusion in Coronary Artery Bypass Graft Surgery

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