National Benchmarks for Proportions of Patients Receiving Blood Transfusions During Pediatric and Congenital Heart Surgery: An Analysis of the STS Congenital Heart Surgery Database

Kartha, Vyas M.; Jacobs, Jeffrey P.; Vener, David F.; Hill, Kevin D.; Goldenberg, Neil A.; Pasquali, Sara K.; Meza, James M.; O’Brien, Sean M.; Li, Feng; Chiswell, Karen; Eghtesady, Pirooz; Badhwar, Vinay; Rehman, Mohamed A.; Jacobs, Marshall L.

doi:10.1016/j.athoracsur.2018.04.088

Cited by 21 publications

(19 citation statements)

References 19 publications

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“…In reviewing the STS and Congenital Cardiac Anesthesia Society database, blood product administration is related to both age and surgical complexity. 34 Not surprisingly, the amount of blood products administered in this current cohort of extremely complex patients, in whom operative, anesthesia, and bypass times were very long, approximates an exchange of approximately three blood volumes.…”

Section: Commentmentioning

confidence: 81%

Transfusion Outcomes in Patients Undergoing Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals

Wise‐Faberowski

Irvin

Quiñónez

et al. 2020

World J Pediatr Congenit Heart Surg

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Background: Surgical repair of tetralogy of Fallot and major aortopulmonary collaterals (TOF/MAPCAs) involves unifocalization of MAPCAs and reconstruction of the pulmonary arterial circulation. Surgical and cardiopulmonary bypass (CPB) times are long and suture lines are extensive. Maintaining patency of the newly anastomosed vessels while achieving hemostasis is important, and assessment of transfusion practices is critical to successful outcomes. Methods: Clinical, surgical, and transfusion data in patients with TOF/MAPCAs repaired at our institution (2013-2018) were reviewed. Types and volumes of blood products used in the perioperative period, in addition to the use of antifibrinolytics and/or procoagulants (factor VIII inhibitor bypassing activity [FEIBA]; anti-inhibitor coagulant complex), were assessed. Outcome measures included days on mechanical ventilation (DOMV), postoperative intensive care unit and hospital length of stay (LoS), and incidence of thrombosis. Results: Perioperative transfusion data from 279 patients were analyzed. Surgical (879 ± 175 minutes vs 684 ± 257 minutes) and CPB times (376 ± 124 minutes vs 234 ± 122 minutes) were longer in patients who received FEIBA than those who did not. Although the indexed volume of packed red blood cells (128.4 ± 82.2 mL/kg) and fresh frozen plasma (64.2 ± 41.1 mL/kg) was similar in patients who did and did not receive FEIBA, the amounts of cryoprecipitate (5.5 ± 5.2 mL/kg vs 5.8 ± 4.8 mL/kg) and platelets (19.5 ± 20.7 mL/kg vs 20.8 ± 13 mL/kg) transfused were more in those who did receive FEIBA. Conclusion: Perioperative transfusion is an important component in the overall surgical and anesthetic management of patients with TOF/MAPCAs. The intraoperative use of FEIBA was not associated with a decrease in the amount of blood products transfused, DOMV, or LoS or with an increase in thrombotic complications.

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Section: Commentmentioning

confidence: 81%

Transfusion Outcomes in Patients Undergoing Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals

Wise‐Faberowski

Irvin

Quiñónez

et al. 2020

World J Pediatr Congenit Heart Surg

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“…In particular, adherence of the anesthetic team is crucial as outlined by Wloch et al 1 Currently, the vast majority of pediatric cardiac surgical units usually add homologous blood in the CPB circuit before starting the extracorporeal circulation in low-weight patients. 18 Our message is that it is worth to commit oneself to a bloodless CPB course, as this strategy is prone to improve outcome, in particular to reduce postoperative mortality (up to 10 times in this series).…”

Section: Discussionmentioning

confidence: 84%

Asanguineous Cardiopulmonary Bypass in Infants: Impact on Postoperative Mortality and Morbidity

Muríň

Boettcher

Ozaki

et al. 2019

Thorac cardiovasc Surg

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Background We routinely start cardiopulmonary bypass (CPB) for pediatric congenital heart surgery without homologous blood, due to circuit miniaturization, and blood-saving measures. Blood transfusion is applied if hemoglobin concentration falls under 8 g/dL, or it is postponed to after coming off bypass or after operation. How this strategy impacts on postoperative mortality and morbidity, in infants weighing ≤ 7 kg? Methods Six-hundred fifteen open-heart procedures performed from January 2014 to June 2018 were selected. One-hundred sixty-three patients (26.5%) were transfused on CPB (group 1), while 452 (73.5%) patients were not transfused on CPB (group 2). Operative risk and complexity were similar in both groups. Postoperative mortality and morbidity were compared. Multiple logistic regression was used to detect factors independently associated with outcome. Results Observed mortality in nontransfused group (0.7% = 3/452) was significantly lower than expected (4.2% = 19/452): p = 0.0007, and much lower than in transfused group (6.7% = 11/163): p < 0.0001. CPB transfusion (p = 0.001) was independently associated with mortality, either acting as the sole factor or in combination with the Society of Thoracic Surgeons morbidity score (p = 0.013). Patients not transfused during CPB required less frequently vasoactive inotropic drugs (p = 0.011) and duration of their mechanical ventilation was shorter (93 ± 134 hours) than for transfused patients (142 ± 170 hours): p = 0.0003. CPB transfusion was an independent determinant factor for morbidity (p = 0.05), together with body weight (p < 0.0001), vasoactive inotropic score (p < 0.0001), CPB duration (p = 0.001), and postoperative transfusion (p = 0.009). Conclusion The strategy of transfusion-free CPB course, feasible in most patients ≤ 7kg, was associated with improved outcome. Asanguineous priming of CPB circuit should become standard, even in neonates and infants.

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“…4,15,16 Publications to date arising from this collaboration include DEX usage as well as recent manuscripts examining the impact of site of intubation (nasal vs oral) on postoperative outcomes and the prevalence of packed red blood cell transfusion. 6,9,17 Other studies in progress led by participating anesthesiologists include evaluating postoperative hematocrit on arrival in the ICU and its effects on perioperative morbidity and mortality as well as the impact of anthropometric measures on congenital heart surgery outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Congenital Cardiac Anesthesia Society—Society of Thoracic Surgeons Cardiac Anesthesia Database Collaboration

Vener

Abbasi

Brown

et al. 2019

World J Pediatr Congenit Heart Surg

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Multi-institutional databases and registries have proliferated over the last decade in all specialties of medicine. They may be especially helpful in low-frequency/high-acuity fields such as pediatric and congenital heart diseases. The Society of Thoracic Surgeon’s Congenital Heart Surgery Database (STSCHSD) is the largest single data set for the congenital heart disease population and includes contemporaneous data from over 120 programs in the United States (and several outside of the United States), capturing greater than 98% of the congenital cardiac surgical procedures in the United States. In 2010, the Congenital Cardiac Anesthesia Society partnered with the STSCHSD to incorporate anesthesia-related elements into the data set. Voluntary site participation in the anesthesia data has grown steadily. Currently, over 60 sites performing more than 60% of cardiac bypass procedures in the STSCHSD are submitting anesthesia data annually into the STSCHSD. Anesthesia data include perioperative medication usage, modalities for hemodynamic and neurologic monitoring, blood product, antifibrinolytic and procoagulant use, and anesthesia-related adverse events. This special article provides a descriptive summary of relevant findings to date, reflecting the wide variety in anesthesia practice patterns present among institutions and illustrates the functionality of a multisite registry in pediatric cardiac anesthesia which can be utilized both locally and nationally.

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National Benchmarks for Proportions of Patients Receiving Blood Transfusions During Pediatric and Congenital Heart Surgery: An Analysis of the STS Congenital Heart Surgery Database

Cited by 21 publications

References 19 publications

Transfusion Outcomes in Patients Undergoing Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals

Transfusion Outcomes in Patients Undergoing Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals

Asanguineous Cardiopulmonary Bypass in Infants: Impact on Postoperative Mortality and Morbidity

The Congenital Cardiac Anesthesia Society—Society of Thoracic Surgeons Cardiac Anesthesia Database Collaboration

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