Risk of massive blood product requirement in cardiac surgery

Abstract

Cardiac surgery under cardiopulmonary bypass (CPB) accounts for most consumption of red blood cells (RBCs). Identifying risk factors for massive red blood cell transfusion (MRT) in cardiac surgery may help to reduce this consumption. We retrospectively analyzed 8238 patients who underwent valve surgery and/or coronary artery bypass grafting (CABG) under CPB at 2 major heart centers in China. Uni- and multivariate logistic regression was carried out to assess whether risk factors for MRT (defined as receiving at least 4 units RBCs) varied with type of cardiac surgery. A total of 1691 patients (21%) received at least 4 units RBCs (6.77 ± 4.78 units per person). This MRT group consumed 70% of the total units of allogeneic RBCs in the study. MRT incidence was 2-fold higher among patients undergoing CABG with or without valve surgery than among patients undergoing valve surgery alone. Multivariate logistic analysis identified the following MRT risk factors common to valve surgery alone, CABG alone, and their combination: female sex, older age, renal dysfunction, lower body mass index, lower preoperative hemoglobin, and longer CPB. Several independent MRT risk factors were also identified specific to valve surgery: active endocarditis, nonatrial fibrillation, smaller left atrium diameter, abnormal international normalized ratio, and repeat surgery. Different types of cardiac surgery share several, but not all, MRT risk factors. This study may help guide the prediction and management of patients at higher MRT risk.

Rapid thrombelastography predicts perioperative massive blood transfusion in patients undergoing coronary artery bypass grafting

“…These findings also provided strong support for the view that reducing MBT can significantly reduce the overall demand for blood products. [ 6 ] In order to evaluate the utility of r-TEG to predict MBT in patients undergoing CABG more definitely, we analyzed the risk factors of MBT in different time periods.…”

“…Previous studies have identified several risk factors associated with MBT in perioperative period of cardiac surgery, including female sex, older age, renal dysfunction, lower body mass index, lower preoperative hemoglobin (Hb) and longer cardiopulmonary bypass (CPB), which predicted MBT during cardiac surgery, [ 6 ] while body surface area, preoperative Hb concentration, preoperative platelet count, urgency of surgery, surgeon, and type of procedure predicted the MBT within 1 day after surgery. [ 5 ] However, the value of using rapid thrombotomography (r-TEG) to predict MBT in perioperative period of cardiac surgery has not been explored.…”

Retrograde inferior vena caval perfusion for total aortic arch replacement surgery (RIVP-TARS): study protocol for a multicenter, randomized, controlled trial

“…Transfusion will be performed if hemoglobin concentration is <7 g/dL during CPB, <8 g/dL during surgery or <9.5 g/dL in the ICU [37]. All patients will be managed in the ICU after the operation.…”

Perioperative blood product transfusion of two different perfusion strategies on pediatric patients undergoing aortic arch surgery

“…The functions of blood products include increasing blood oxygen capacity, maintaining plasma osmotic pressure, ameliorating microcirculation, enhancing coagulation function, and improving immunity. The consumption of perioperative blood products may affect early clinical outcomes as well as long‐term prognosis of patients . No matter which perfusion strategy is performed, the transfusion of blood products is still indispensable in pediatric aortic arch surgeries.…”

“…The consumption of perioperative blood products may affect early clinical outcomes as well as long-term prognosis of patients. 5 No matter which perfusion strategy is performed, the transfusion of blood products is still indispensable in pediatric aortic arch surgeries. However, substantial gaps in our knowledge remain with regard to the perioperative use of blood products in children under these two perfusion methods.…”