Blood transfusion – ABC CARDIOL

IJCS

Editorial

Lower Rate of Blood Transfusion after Heart Surgery in a Tertiary Hospital

Special interest in surgical bleeding and methods to limit its occurrence is growing after the possibility that transfusion of blood products might be causally related to complications and negative outcomes has been raised. In the same vein, studies have been conducted to evaluate whether limiting blood product transfusions (ie, being more conservative in the indication for it) would increase the safety of transfusion or even reduce some patterns of complications. The current study is a contribution to this larger discussion.

Moraes et al. report the experience of a large tertiary center in bleeding patterns after heart operations. Four hundred and twenty-three patients (51% coronary artery bypass surgery and 33% valve operations) were evaluated for total bleeding and for the use of blood products. Perioperative bleeding was measured by weighing sponges, a validated method for a difficult enterprise. Postoperative bleeding was determined by the total chest tube output in the first 24 h after the end of the operation.

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IJCS

Original Article

Adverse Events and Risk Factors of Blood Transfusion in Cardiovascular Surgery: A Prospective Cohort Study

Ana Paula Tagliari et al. Lucas Molinari Veloso da Silveira Adriano Nunes Kochi Anderson Castro de Souza … Marcelo Curcio Gib Tanara Martins de Freitas Cristiano Blaya Martins Leandro Totti Cavazzola Orlando Carlos Belmonte Wender

Abstract

Background:

Hemodilution, transoperative bleeding and cardiopulmonary bypass (CPB) are some of the factors associated with high transfusion rates in cardiac surgery.

Objective:

To analyze the incidence of blood transfusion and early postoperative outcomes in cardiac surgery patients.

Methods:

Cohort study of patients undergoing cardiac surgery in a university hospital, consecutively enrolled from May 2015 to February 2017. Data were prospectively collected and comparisons were made between two patients’ groups: transfused and not transfused. Student’s t-test, chi-square test, and logistic regression were used, and a p-value < 0.05 was considered significant.

Results:

Among the 271 patients evaluated, 100 (37%) required transfusion in the transoperative (32.1%) and/or postoperative periods (19.5%). The following predictors of transfusion were identified by multivariate analysis: EuroScore II (OR 1.2); chronic kidney disease (CKD) (OR 3.2); transoperative bleeding ≥ 500 mL (OR 6.7); baseline hemoglobin (Hb) ≤ 10 g/dL (OR 11.5); activated partial thromboplastin time (aPTT) (OR 1.1) and CPB duration (OR 1.03). Transfusion was associated with prolonged mechanical ventilation (≥ 24h) (2.4% vs. 23%), delirium (5.9% vs. 18%), bronchopneumonia (1.2% vs. 16%), acute renal failure (3.5% vs. 25%), acute on CKD (0.6% vs. 8%), stroke or transient ischemic attack (1.8% vs. 8%), intensive care unit stay ≥ 72 h (36% vs. 57%), longer hospital stay (8 ± 4 days vs. 16 ± 15 days), as well as increased early mortality (1.75% vs. 15%).

Conclusion:

EuroScore II, CKD, major transoperative bleeding, preoperative Hb and aPTT values and CPB time were independent predictors of transfusion, which was associated with a higher rate of adverse outcomes, including early mortality.