Optimal Blood Transfusion Practice in Cardiac Surgery

Tempe, Deepak K; Khurana, Priyanka

doi:10.1053/j.jvca.2018.05.051

Cited by 13 publications

(10 citation statements)

References 33 publications

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“…Preoperative anemia also increases perioperative red blood cell (RBC) transfusion rates in cardiac surgery patients [1,9]. Allogeneic blood transfusions are a scarce and costly resource that carry with them significant risks including transfusion reactions, transfusion-related immunomodulation, infectious complications, and other systemic adverse effects [1,[9][10][11]. Similar to preoperative anemia, blood transfusion in cardiac surgery is associated with increased morbidity and mortality, lengths of hospital stay, and health care costs [2,9].…”

Section: Introductionmentioning

confidence: 99%

Preoperative anemia and transfusion in cardiac surgery: a single-centre retrospective study

Nguyen

Meng

Berube

et al. 2021

J Cardiothorac Surg

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Background Preoperative anemia and transfusion are associated with worse outcomes. This study aims to identify the prevalence of preoperative anemia, transfusion rates on surgery day, and predictors of transfusion in elective cardiac surgery patients at our centre. We also aim to evaluate our preoperative intervention program, and examine the intervention window for anemia before surgery. Methods This study included 797 adult patients who underwent elective cardiac surgery at a tertiary hospital. Multivariable logistic regression analysis was used to identify predictors of transfusion on surgery day. Results Preoperative anemia was present in 15% of patients. Anemic patients had a significantly higher transfusion rate at 53% compared to 10% in non-anemic patients. Hemoglobin concentration, estimated glomerular filtration rate (eGFR), body surface area (BSA), and total cardiopulmonary bypass time were predictive of transfusion on surgery day. Patients had a median of 7 days between initial visit and surgery day, however, referral to the blood conservation clinic was only done for 8% of anemic patients and treatment was initiated in 3% of anemic patients. Among the 3 anemic patients who received treatment, 2 did not require blood transfusion on surgery day. Conclusions Preoperative anemia is present in 15% of patients at our centre and these patients have 53% transfusion rates on surgery day. Hemoglobin concentration, eGFR, BSA, and total cardiopulmonary bypass time were predictors of transfusion on surgery day. Patients had a median of 7 days between initial visit and surgery day. Referral and anemia treatment were infrequently initiated in preoperative anemic patient.

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Section: Introductionmentioning

confidence: 99%

Preoperative anemia and transfusion in cardiac surgery: a single-centre retrospective study

Nguyen

Meng

Berube

et al. 2021

J Cardiothorac Surg

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“…This is also compatible with our institutional policy that we use restricted blood-blood products for drainages not causing clinical and hemodynamic deteriotaion. 22 The late outcomes of the both tecniques were analysed in the literature, there was no statistically significant difference. 23 The most important factor affecting the late period outcomes is the incidence of reoperations.…”

Section: Discussionmentioning

confidence: 96%

Complete Atrioventricular Septal Defect: Two-Patch Techniques and Modified Single Patch, Application-Outcomes.

Arslan

Aksoy

et al. 2021

Preprint

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The life expectancy and quality of patients with complete atrioventricular septal defect (CAVSD), which has undergone significant modifications in surgical correction since its definition, are increasing. Materials and Methods A total of 56 patients with a median age of 9 months were operated in the last 10 years. The modified single-patch (MSP) and two-patch technique (TPT) were applied to 37 patients and 19 patients, respectively. The patients were compared in terms of the ventricular septal defect (VSD) diameter, cardio pulmoner bypass (CPB) and aortic cross-clamp (ACC) time, intubation time, length of intensive care unit (ICU) in addition to demographic and hospital data. Long term results of 45 patients have been evaluated for 73,2 ± 4,06 months meanly. Results It was observed that the age distribution of the patients who underwent MSP was lower (p=0.003), and were more female patients (p=0.023). The VSD diameter was larger in the TPT (p=0.000). The right atrioventricular valve (RAVV) repair was observed significantly more in the MSP technique (p=0.043). CPB and ACC time were found to be significantly longer in the TPT technique according to the T-test result. While postoperative LAVV regurgitation was found to be lower in the MSP (p=0.016), the amount of drainage was higher in the TPT. No statistical significance was detected in other comparative values of early and the long term results of the both tecniques. Conclusion In this retrospective study, it was observed that the MSP was advantageous in surgical outcomes, its easier applicability in accordance with the literature.

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“…As an established risk factor reflecting systemic dysfunction and cardiovascular disease in the general population (14), anemia is a common comorbidity in perioperative patients (2,4). It has been shown that the combination of anemia and blood transfusion carries additive risks for the incidence of adverse outcomes (15), and increasing units of RBC transfusion are associated with worse outcomes (16,17). Previous studies showed that perioperative RBC transfusion in cardiac surgery could increase patients' risk of death, regardless of the amount of blood units (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Association Between Perioperative Red Blood Cell Transfusion and Postoperative Cardiac Surgery Outcomes

Cheang

Zhang

et al. 2021

Front. Cardiovasc. Med.

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Objective: To investigate the correlation between red blood cell transfusion and clinical outcome in patients after cardiac surgery.Methods: Demographic, clinical characteristics, treatment with/without transfusion, and outcomes of patients after cardiac surgery from the Medical Information Mart for Intensive Care—III database were collected. Patients were divided into two groups according to perioperative transfusion. A multivariable logistic regression analysis was utilized to adjust for the effect of red blood cell transfusion on outcomes for baseline and covariates and to determine its association with outcomes.Results: In total, 6,752 patients who underwent cardiac surgery were enrolled for the analysis. Among them, 2,760 (40.9%) patients received a perioperative transfusion. Compared with patients without red blood cell transfusion, transfused patients demonstrated worse outcomes in inhospital mortality, 1-year mortality, and all-cause mortality. Adjusting odds ratios (ORs) for the significant characteristic, patients with perioperative transfusion remained significantly associated with an increased risk of inhospital mortality [OR = 2.8, 95% confidence interval (CI) 1.5–5.1, P = 0.001], 1-year mortality (OR = 2.0, 95% CI 1.4–2.7, P < 0.001), and long-term mortality (OR = 2.2, 95% CI 1.8–2.8, P < 0.001).Conclusion: Perioperative red blood cell transfusion is associated with a worse prognosis of cardiac surgery patients. Optimal perioperative management and restricted transfusion strategy might be considered in selected patients.

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Optimal Blood Transfusion Practice in Cardiac Surgery

Cited by 13 publications

References 33 publications

Preoperative anemia and transfusion in cardiac surgery: a single-centre retrospective study

Preoperative anemia and transfusion in cardiac surgery: a single-centre retrospective study

Complete Atrioventricular Septal Defect: Two-Patch Techniques and Modified Single Patch, Application-Outcomes.

Prognostic Association Between Perioperative Red Blood Cell Transfusion and Postoperative Cardiac Surgery Outcomes

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