Total arterial coronary artery bypass grafting in patients with preoperative anemia

Abstract

Objectives Blood transfusions after coronary artery bypass grafting (CABG) has been associated to adverse outcomes, especially in anemic patients. However, little is known about the influence of the modality of revascularization. Total arterial revascularization (TAR) was shown to reduce postoperative transfusion when compared to saphenous vein‐based (SV)‐CABG (LIMA plus one/more SV grafts). We, therefore, aimed to investigate the impact of TAR‐CABG versus SV‐CABG on blood products use and perioperative outcomes in patients with preoperative anemia, normally at higher risk for postoperative transfusions. Methods From a cohort of 936 patients with mild preoperative anemia undergoing primary elective on‐pump CABG, 166 matched pairs of patients undergoing either TAR‐ or SV‐CABG were obtained. Anemia was defined as hemoglobin level <13 g/dl for men and <12 g/dl for women. The primary endpoint was the evaluation of red packed cells (RPC) use over the entire hospital stay. Results TAR patients showed significantly reduced RPC usage compared with SV (mean difference 0.45 units). TAR patients had a reduced intubation time (mean difference 7.6 h) and were discharged 1.24 days earlier than SV patients. Pneumonia and acute kidney injury were doubled among SV patients. Adjusted regression showed that TAR technique is a predictor of reduced RPC unit use regardless of age and EuroSCORE II (odds ratio: 0.63, p < .01). Conclusion Patients with preoperative anemia might benefit from TAR regardless of age or calculated operative risk. TAR‐CABG was associated to reduced postoperative use of blood products and postoperative length of stay in comparison with SV‐CABG in this subset of patients.

Effect of hemoglobin and oxygen saturation on adverse outcomes in children with tetralogy of fallot: a retrospective observational study

“…Several studies have demonstrated that preoperative anemia can increase morbidity and mortality, prolong ICU and hospital stay times in adult cardiac surgery [ 13 , 14 ]. The pathophysiology basis of anemia is the reduction of oxygen-carrying capacity for Hb, which can result in tissue hypoxia and organ dysfunction [ 15 ].…”