Hematocrit on Cardiopulmonary Bypass and Outcome After Coronary Surgery in Nontransfused Patients

Ranucci, Marco; Conti, Daniela; Castelvecchio, Serenella; Menicanti, Lorenzo; Frigiola, Alessandro; Ballotta, Andrea; Pasqui, Gabriele

doi:10.1016/j.athoracsur.2009.07.078

Cited by 96 publications

(64 citation statements)

References 23 publications

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“…Expanding clinical evidence suggests that acute hemodilution is associated with increased organ injury and mortality. 2,[15][16][17] Hemodilution increases the risk of stroke Acute stroke is a catastrophic complication associated with hemodilution during cardiopulmonary bypass (CPB). 2,12 Although exact mechanisms have not been defined, experimental studies suggest that tissue hypoxia contributes.…”

Section: The Risk Of Hemodilutional Anemiamentioning

confidence: 99%

“…18 While a specific safe threshold hematocrit has not been established, prevention of a fall in the hematocrit to \ 25% may be beneficial in terms of reduced neurological injury and morbidity. 17,19 In patients with cardiovascular disease, an increase in stroke incidence has been observed at relatively high Hb (* 130 gÁL -1 ), 20 while low preoperative Hb (* 120 gÁL -1 ) 3,10 and low intraoperative Hb (* 70 gÁL -1 ) 2,12 in surgical patients have been associated with progressive increases in the incidence of stroke. Clearly, the presence of arterial disease (fixed obstructions, endothelial dysfunction) in such patients limits the extent to which oxygen delivery can be maintained by increased blood flow.…”

Section: The Risk Of Hemodilutional Anemiamentioning

confidence: 99%

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Reassessing the risk of hemodilutional anemia: Some new pieces to an old puzzle

Tsui

Dattani

Marsden

et al. 2010

Can J Anesth/J Can Anesth

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Section: The Risk Of Hemodilutional Anemiamentioning

confidence: 99%

Section: The Risk Of Hemodilutional Anemiamentioning

confidence: 99%

Reassessing the risk of hemodilutional anemia: Some new pieces to an old puzzle

Tsui

Dattani

Marsden

et al. 2010

Can J Anesth/J Can Anesth

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“…Individuals who are anemic preoperatively have an increased risk of postoperative kidney failure [2] and death, among other postoperative complications [3, 4], although other studies have failed to find similar results [5]. Some studies have emphasized the importance of the preoperative hemoglobin level [6] in predicting postoperative complications, with others emphasizing the nadir hematocrit level [7] as being the most important. In other studies, a low hematocrit during cardiopulmonary bypass (CPB) has been associated with higher odds of postoperative stroke [1].…”

mentioning

confidence: 99%

Intraoperative Hemoglobin Levels and Transfusion Independently Predict Stroke After Cardiac Operations

Bahrainwala

Grega

Hogue

et al. 2011

The Annals of Thoracic Surgery

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Background Anemia has been associated with adverse cerebrovascular outcomes, particularly after cardiac operations. This study was conducted to determine if hemoglobin levels during and after cardiopulmonary bypass (CPB) predict postoperative stroke in cardiac surgical patients, independent of transfusion requirements. Methods Individuals who had sustained a clinical postoperative stroke (cases) were matched 1:2 with controls by age, sex, surgical procedure, and year of operation. In 617 patients, conditional logistic regression was performed to analyze associations between hemoglobin levels before and after CPB, and stroke. Results After adjustment for potentially confounding vascular risk factors, lower hemoglobin after CPB was associated with a higher risk of stroke, even after adjustment for the amount of packed red blood cells transfused (adjusted odds ratio, 1.28; 95% confidence interval, 1.00 to 1.64, per point of lower hemoglobin level; adjusted odds ratio for stroke per higher quartile of packed red blood cells transfused in this model, 1.37; 95% confidence interval, 1.02 to 1.83). Similar associations were not found for hemoglobin concentrations preoperatively nor change in hemoglobin from before to after CPB. A post-CPB hemoglobin level below the median was associated with 37% increased odds of a postoperative stroke occurring (p = 0.02). Conclusions Lower postoperative hemoglobin levels and higher intraoperative transfusion requirements are each independently associated with a higher risk of stroke. Reduced cerebral oxygen delivery due to anemia may contribute to cerebral injury after coronary artery bypass grafting.

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“…Patients with low hematocrit had significantly higher rates of bleeding, and one or more complications than patients with normal hematocrit after adjusting for other factors. Other studies have found some of these complications to be more prevalent among patients with low hematocrit, including renal failure, 4,5,7 bleeding, 5 and respiratory failure 5 …”

Section: Discussionmentioning

confidence: 99%