Transfusion of red blood cells: the impact on short-term and long-term survival after coronary artery bypass grafting, a ten-year follow-up

Abstract

Transfusion of red blood cells (RBC) and other blood products in patients undergoing coronary artery bypass grafting (CABG) is associated with increased mortality and morbidity. We retrospectively analyzed data of patients who underwent an isolated coronary bypass graft operation between January 1998 and December 2007. Mean follow-up was 1696+/-1026 days, with exclusion of 122 patients lost to follow-up and 80 patients who received 10 units of RBC. Of the remaining patients, 8001 (76.7%) received no RBC, 1621 (15.2%) received 1-2 units of RBC, 593 (5.7%) received 3-5 units and 220 (2.1%) received 6-10 units. The number of transfused RBC was a predictor for early but not for late mortality. When compared to expected survival, survival of patients not receiving any blood product was better, while survival of patients receiving >3 units of RBC was worse. Transfusion of RBC is an independent, dose-dependent risk factor for early mortality after revascularization. Compared to expected survival, receiving no RBC improves patient long-term survival, whereas receiving three or more units of RBC significantly decreases patient survival.

The Incidence of Acute Kidney Injury after Coronary Artery Bypass Surgery with or without Cardiopulmonary Bypass

“…Increased blood glucose is more associated with CCABG than beating heart coronary revascularization (37). Blood transfusion has been introduced as an operation outcome reducer (38). Studies show that blood transfusion is higher in on-pump patients (39), we have similar results.…”

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…1029 -1032 A prospective observational study of 8004 patients demonstrated that the transfusion of allogeneic red blood cells in CABG patients was associated with an increased risk of low-output heart failure irrespective of the extent of hemodilutional anemia. 1030 An adverse outcome may be caused by immunomodulation (known to occur with red blood cell transfusion), initiation of a systemic inflammatory response and its associated direct negative myocardial effects, reduced red blood cell capacity for adequate oxygen delivery 1031,1032 (diphosphoglycerate function in "banked" blood may cause tissue hypoxia), and changes in red blood cell morphology of transfused blood. Regardless of etiology, myocardial depression is observed consistently after allogeneic red blood cell transfusion, and this effect appears to be dose dependent.…”

O impacto da hemotransfusão na morbimortalidade pós-operatória de cirurgias cardíacas

“…According to the study conducted by van Straten et al [21], the number of units transfused may be a predictor of early mortality (up to 30 days in the postoperative period), but not of late mortality. Comparing the expected survival, the authors concluded that in patients who received three or more units of RBC, the survival rate drops significantly when compared to patients who did not receive hemoderivative products.…”

“…Blood transfusion can also initiate a secondary inflammatory response by modifying the systemic inflammatory response of the patients and the direct introduction of bioactive substances into circulation, in addition to the primary inflammatory response initiated by the extracorporeal circulation [21][22][23].…”