Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure

• Published in: Circulation (New York, N.Y.) Vol. 114; no. 1; pp. I43 - I48
• Main Authors: SURGENOR, Stephen D, DEFOE, Gordon R, KRUMHOLZ, Charles F, WESTBROOK, Benjamin M, GALATIS, Dean J, FRUMIENTO, Carmine, ROSS, Cathy S, OLMSTEAD, Elaine M, O'CONNOR, Gerald T, FILLINGER, Mary P, LIKOSKY, Donald S, GROOM, Robert C, CLARK, Cantwell, HELM, Robert E, KRAMER, Robert S, LEAVITT, Bruce J, KLEMPERER, John D
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 04-07-2006
• Subjects: Aged; Aged, 80 and over; Anemia - etiology; Anemia - therapy; Biological and medical sciences; Blood and lymphatic vessels; Blood Loss, Surgical; Blood Transfusion - standards; Blood Transfusion - statistics & numerical data; Blood. Blood coagulation. Reticuloendothelial system; Cardiac Output, Low - drug therapy; Cardiac Output, Low - epidemiology; Cardiac Output, Low - etiology; Cardiac Output, Low - surgery; Cardiology. Vascular system; Cardiopulmonary Bypass - adverse effects; Cardiotonic Agents - therapeutic use; Cohort Studies; Coronary Artery Bypass; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Guideline Adherence; Heart Failure - drug therapy; Heart Failure - epidemiology; Heart Failure - etiology; Heart Failure - surgery; Hematocrit; Humans; Hypoxia-Ischemia, Brain - etiology; Hypoxia-Ischemia, Brain - prevention & control; Intra-Aortic Balloon Pumping; Intraoperative Complications - etiology; Intraoperative Complications - therapy; Maine - epidemiology; Male; Medical sciences; Middle Aged; New Hampshire - epidemiology; Pharmacology. Drug treatments; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Practice Guidelines as Topic; Practice Patterns, Physicians' - statistics & numerical data; Prospective Studies; Risk; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Transfusion Reaction; Vermont - epidemiology; Heart failure; Postoperative; Transfusion; Anemia; Mortality; Red blood cell; blood cells; Cardiovascular disease; Intraoperative; Hemopathy; Coronary heart disease; Cardiopulmonary bypass; Blood cell; Surgery; Risk factor
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.105.001271

Hemodilutional anemia during cardiopulmonary bypass (CPB) is associated with increased mortality during coronary artery bypass graft (CABG) surgery. The impact of intraoperative red blood cell (RBC) transfusion to treat anemia during surgery is less understood. We examined the relationship between anemia during CPB, RBC transfusion, and risk of low-output heart failure (LOF).
Data were collected on 8004 isolated CABG patients in northern New England between 1996 and 2004. Patients were excluded if they experienced postoperative bleeding or received > or = 3 units of transfused RBCs. LOF was defined as need for intraoperative or postoperative intra-aortic balloon pump, return to CPB, or > or = 2 inotropes at 48 hours. Having a lower nadir HCT was also associated with an increased risk of developing LOF (adjusted odds ratio, 0.90; 95% CI, 0.82 to 0.92; P=0.016), and that risk was further increased when patients received RBC transfusion. When adjusted for nadir hematocrit, exposure to RBC transfusion was a significant, independent predictor of LOF (adjusted odds ratio, 1.27; 95% CI, 1.00 to 1.61; P=0.047).
In this study, we observed that exposure to both hemodilutional anemia and RBC transfusion during surgery are associated with increased risk of LOF, defined as placement of an intraoperative or postoperative intra-aortic balloon pump, return to CPB after initial separation, or treatment with > or = 2 inotropes at 48 hours postoperatively, after CABG. The risk of LOF is greater among patients exposed to intraoperative RBCs versus anemia alone.