Mild volume acute normovolemic hemodilution is associated with lower intraoperative transfusion and postoperative pulmonary infection in patients undergoing cardiac surgery -- a retrospective, propensity matching study

Abstract

BackgroundPerioperative allogenic transfusion is required in almost 50% of patients undergoing cardiac surgery and is associated with higher risk of mortality and morbidity (Xue et al., Lancet 387:1905, 2016; Ferraris et al., Ann Thorac Surg 91:944–82, 2011). Acute normovolemic hemodilution (ANH) is recommended as a potential strategy during cardiac surgery, but the blood conservation effect and the degree of ANH was still controversial. There is also an increasing concern about the improved outcomes associated with ANH. Therefore, a better understanding of the effect of mild volume ANH during cardiac surgery is urgently needed.MethodsThis retrospective study included 2058 patients who underwent cardiac surgery between 2010 and 2015. The study population was split into two groups (with and without mild volume ANH). Propensity score adjustment analysis was applied. We reported the association between the use of mild volume ANH and perioperative outcomes.ResultsA total of 1289 patients were identified. ANH was performed in 358 patients, and the remaining 931 patients did not receive any ANH. Five hundred of the total patients (38.8%) received perioperative RBC transfusions, 10% (129/1289) of patients received platelet, and 56.4% (727/1289) of patients received fresh frozen plasma transfusions. Mild volume ANH administration was significantly associated with decreased intraoperative RBC transfuse rate (8.5% vs. 14.4%; p = 0.013), number of RBC units (p = 0.019), and decreased postoperative pulmonary infection (6.8 vs. 11.3%; p = 0.036) during cardiac surgery. However, there was no significant difference regarding intraoperative fresh frozen plasma (FFP) and platelet concentrate transfusions, as well as postoperative and total perioperative allogeneic transfusions. Furthermore, there was no significant difference regarding postoperative outcomes including mortality, prolonged wound healing, stroke, atrial fibrillation, reoperation for postoperative bleeding and acute kidney injury. There was also no difference in postoperative ventilation time, length of ICU and hospital stay.ConclusionBased on the 5-year experience of mild volume ANH in cardiac surgeries with CPB in our large retrospective cohort, mild volume ANH was associated with decreased intraoperative RBC transfusion and postoperative pulmonary infection in Chinese patients undergoing cardiac surgery. However, there was no significant difference regarding postoperative and total perioperative allogeneic transfusions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0305-7) contains supplementary material, which is available to authorized users.

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients

“…In a propensity score-matched retrospective analysis Zhou and colleagues reported that ANH was associated with decreased RBC transfusions and a decreased risk for postoperative pulmonary infections. 74 In a recently published meta-analysis that included 2,439 patients in 29 randomized controlled trials, ANH was associated with a reduced need for RBC transfusions and reduced postoperative bleeding. 75 It seems that in order to achieve maximal benefit of ANH, 800 mL or more of blood needs to be removed before surgery.…”

Blood conservation in cardiac surgery

“…It appeared that the protective effect of ANH was related to the volume of blood removed, with patients in the 800 mL or greater group having fewer transfusions and better outcomes. A retrospective analysis conducted in cardiac surgical patients showed that although ANH decreased the intra‐operative RBC transfusion rate and the number of units transfused, no significant difference regarding post‐operative and total perioperative ABT was observed (Zhou et al, ). This lack of long‐term benefit could partly be explained by the small amount of blood removed in that study.…”

Novel risk factors for the healthcare associated infections (HAIs) in patients with Stanford type A aortic dissection (TAAD)

“…Patients with TAAD undergoing surgical repair are at higher risk for postoperative infections. Because it usually mixed up a variety of risk factors which contribute to HAIs, such as cardiac surgeries (19), long duration of surgery time, mechanical ventilation. In this study, we firstly investigated the risk factors of HAIs for the patients with TAAD after surgical treatment.…”