Impact on early and late mortality after blood transfusion in coronary artery bypass graft surgery

Santos, Antônio Alceu dos; Sousa, Alexandre Gonçalves de; Thomé, Hugo Oliveira de Souza; Machado, Roberta Longo; Piotto, Raquel Ferrari

doi:10.5935/1678-9741.20130003

Cited by 7 publications

(7 citation statements)

References 27 publications

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“…In a recent study it was demonstrated that the RBCT is an independent predictor for both, 30 day mortality (OR 2.00; P = 0.007) and one year mortality (OR 2.31; P = 0.003), after CABG surgery. Even in low-risk patients (age <60 years and with EuroSCORE ≤ 2%), hence with fewer comorbidities, there were significantly more deaths in the transfused group within both periods 30 day (7.0% vs. 0.0%, P <0.001) and 1 year period (10.0% vs. 0.0%, P <0.001) [ 9 ] . Transfusions above four PRBCs units are associated with progressively greater mortality either in general surgery [ 13 ] and cardiovascular surgery [ 6 , 10 , 11 , 15 ] .…”

Section: Discussionmentioning

confidence: 99%

“…In the literature the relationship between RBCT and increased clinical complications after cardiac surgery is already strongly established, such as infections, chronic kidney failure (CKF), congestive heart failure (CHF), atrial fibrillation (AF), stroke [ 5 , 6 ] malignancies [ 7 ] . In the last decade, several studies have shown reduced survival after transfusion of packed red blood cells (PRBCs) [ 6 , 8 , 9 ] , especially with massive transfusions [ 6 , 10 ] . As evidenced in a recent study (2013), the allogeneic blood transfusion is an independent predictor of early and late mortality after coronary artery bypass grafting (CABG) [ 9 ] .…”

Section: Introductionmentioning

confidence: 99%

“…In the last decade, several studies have shown reduced survival after transfusion of packed red blood cells (PRBCs) [ 6 , 8 , 9 ] , especially with massive transfusions [ 6 , 10 ] . As evidenced in a recent study (2013), the allogeneic blood transfusion is an independent predictor of early and late mortality after coronary artery bypass grafting (CABG) [ 9 ] . These evidences help physicians to increasingly adopt a restrictive behavior regarding the RBCT [ 11 , 12 ] .…”

Section: Introductionmentioning

confidence: 99%

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Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft

Santos¹,

Sousa²,

Piotto³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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IntroductionTransfusions of one or more packed red blood cells is a widely strategy used in cardiac surgery, even after several evidences of increased morbidity and mortality. The world's blood shortage is also already evident. ObjectiveTo assess whether the risk of mortality is dose-de>pendent on the number of packed red blood cells transfused after coronary artery bypass graft. MethodsBetween June 2009 and July 2010, were analyzed 3010 patients: transfused and non-transfused. Transfused patients were divided into six groups according to the number of packed red blood cells received: one, two, three, four, five, six or more units, then we assess the mortality risk in each group after a year of coronary artery bypass graft. To calculate the odds ratio was used the multivariate logistic regression model. ResultsThe increasing number of allogeneic packed red blood cells transfused results in an increasing risk of mortality, highlighting a dose-dependent relation. The odds ratio values increase with the increased number of packed red blood cells transfused. The death's gross odds ratio was 1.42 (P=0.165), 1.94 (P=0.005), 4.17; 4.22, 8.70, 33.33 (P<0.001) and the adjusted death's odds ratio was 1.22 (P=0.43), 1.52 (P=0.08); 2.85; 2.86; 4.91 and 17.61 (P<0.001), as they received one, two, three, four, five, six or more packed red blood cells, respectively. ConclusionThe mortality risk is directly proportional to the number of packed red blood cells transfused in coronary artery bypass graft. The greater the amount of allogeneic blood transfused the greater the risk of mortality. The current transfusion practice needs to be reevaluated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft

Santos¹,

Sousa²,

Piotto³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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“…Çalışmamızda intraoperatif parametrelerden KPB süresi ve kros klemp süresi istatistiksel olarak anlamlı bulundu. Literatürde benzer şekilde destekleyen raporlar mevcut (3,(13)(14)(15)(16)(17) . Bu parametrelerin ayrıca transfüzyona olan ihtiyacı artıracağı da bilinmektedir.…”

Section: Discussionunclassified

Effects of Blood Transfusion on Hospital Mortality During Coronary Artery Bypass Grafting

Kalender¹,

Baysal²,

Dağlı³

et al. 2019

Kosuyolu Heart Journal

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Kan transfüzyonu kalp cerrahisinde hayat kurtarıcı olabildiği gibi ölümcül de olabilmektedir. Son yıllarda kan ürünlerinin kullanımının azaltılması yönünde deliller artmıştır. Kan ürünlerinin hem erken dönem hem de geç dönem artmış mortalite ile birlikteliğini destekleyen pek çok yazı mevcut. Ancak transfüzyonun açık kalp cerrahisi uygulanan hastalarda hangi aşamada daha tehlikeli olduğuna dair delil az bulunmaktadır. Bu sebeple biz intraoperatif kan transfüzyonu uygulanmış hastalarda görülen mortalite oranı ile postoperatif kan transfüzyonu uygulanmış hastalarda görülen mortaliteyi kıyasladık. Hastalar ve Yöntem: Çalışma Nisan 2008 ve Şubat 2013 tarihlerinde 108 (%78.8)'i erkek, 29 (%21.2)'u kadın olmak üzere toplam 137 olgu ile yapılmıştır. Çalışmaya dahil ettiğimiz hastalarda kardiyopulmoner baypas (KPB) sırasında hedef hematokrit %20-25 KPB sonrasıda hedef %25-%30 olarak belirlendi. Postoperatif dönemde hastalarımızda eğer anemiye sekonder semptom yok ise hedef hematokrit %26'nın üzeri olarak belirlendi. Ancak semptomatik hastalarda semptom giderilmesi hedeflendi. Taze donmuş plazma (TDP) sadece hacim genişletmek için değil ayrıca koagülapatinin düzeltilmesi içinde kullanıldı. Anemi düzeltilmesi için sadece eritrosit süspansiyonu (ES) transfüzyonu sağlandı. Bulgular: Çalışma 108 (%78.8)'i erkek, 29 (%21.2)'u kadın olmak üzere toplam 137 olgu ile yapılmıştır. Olguların yaşları 36 ile 82 yıl arasında değişmekte olup, ortalama yaş 60.88 ± 9.84 yıldır. Olguların 109 (%79.6)'u yaşamakta iken, 28 (%20.4)'i eksitus olmuştur. Operasyon sırasında kullanılan eritrosit miktarı iki ve daha fazla olduğunda eksitusu öngörmedeki duyarlılığı %46.43, özgüllüğü %81.65, pozitif kestirim değeri %36.39 ve negatif kestirim değeri %85.58 saptanmıştır. Sonuç: Baypas uygulanan hastalarda intraoperatif transfüzyon hastane mortalitesi üzerine olumsuz etkisi mevcut. Bu haliyle peroperatif dönemde tranfüzyondan kaçınmak için gerekli önlemlerin alınması uygun olur.

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“…In our research, we have found that transfusion of red cells was an independent predictor factor of death after CABG in a population of 1,888 patients. Even in a subgroup of low-risk patients (age < 60 years and EuroSCORE < 2%), there was a significant higher mortality rate in the group who had received blood transfusions [ 9 ] .…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Options to Minimize Allogeneic Blood Transfusions and Their Adverse Effects in Cardiac Surgery: A Systematic Review

Santos¹,

Silva²,

Silva³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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IntrodutionAllogeneic blood is an exhaustible therapeutic resource. New evidence indicates that blood consumption is excessive and that donations have decreased, resulting in reduced blood supplies worldwide. Blood transfusions are associated with increased morbidity and mortality, as well as higher hospital costs. This makes it necessary to seek out new treatment options. Such options exist but are still virtually unknown and are rarely utilized.ObjectiveTo gather and describe in a systematic, objective, and practical way all clinical and surgical strategies as effective therapeutic options to minimize or avoid allogeneic blood transfusions and their adverse effects in surgical cardiac patients.MethodsA bibliographic search was conducted using the MeSH term “Blood Transfusion” and the terms “Cardiac Surgery” and “Blood Management.” Studies with titles not directly related to this research or that did not contain information related to it in their abstracts as well as older studies reporting on the same strategies were not included.ResultsTreating anemia and thrombocytopenia, suspending anticoagulants and antiplatelet agents, reducing routine phlebotomies, utilizing less traumatic surgical techniques with moderate hypothermia and hypotension, meticulous hemostasis, use of topical and systemic hemostatic agents, acute normovolemic hemodilution, cell salvage, anemia tolerance (supplementary oxygen and normothermia), as well as various other therapeutic options have proved to be effective strategies for reducing allogeneic blood transfusions.ConclusionThere are a number of clinical and surgical strategies that can be used to optimize erythrocyte mass and coagulation status, minimize blood loss, and improve anemia tolerance. In order to decrease the consumption of blood components, diminish morbidity and mortality, and reduce hospital costs, these treatment strategies should be incorporated into medical practice worldwide.

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Impact on early and late mortality after blood transfusion in coronary artery bypass graft surgery

Cited by 7 publications

References 27 publications

Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft

Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft

Effects of Blood Transfusion on Hospital Mortality During Coronary Artery Bypass Grafting

Therapeutic Options to Minimize Allogeneic Blood Transfusions and Their Adverse Effects in Cardiac Surgery: A Systematic Review

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