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Blood transfusion in cardiac surgery
1Department of Surgery, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. rthurer@caregroup.harvard.edu
Insights
Transfusion practices in cardiac surgery vary significantly despite blood conservation efforts. Continued research is needed to minimize transfusions due to risks and costs.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Cardiothoracic surgeons and anesthesiologists have long focused on appropriate transfusion therapy.
- Cardiac surgery patients face risks from both bleeding and transfusions.
Purpose of the Study:
- To review transfusion practices, risks, and new technologies in cardiac surgery.
- To highlight variations in transfusion patterns and their implications.
Main Methods:
- Literature review on transfusion variability, risks (infectious and non-infectious), and technology impact.
- Presentation of data from a specific cardiac surgery registry.
Main Results:
- Blood conservation strategies (salvage, hemodilution, drugs) exist but practices vary widely.
- Transfusion-transmitted disease risks are reduced, but overall transfusion rates are increasing.
- Non-infectious transfusion hazards remain significant; newer surgical techniques may reduce blood use.
Conclusions:
- Minimizing transfusions in cardiac surgery is crucial due to cost, availability, and potential harm.
- Ongoing research and development of methods to reduce transfusion necessity are vital.
Purpose:
Cardiothoracic surgeons and anesthesiologists have had a long-standing interest in the proper use of transfusion therapy for their patients.
Source:
We review the literature on variability and patterns of transfusion practices in cardiac surgery, on the infectious and noninfectious risks of transfusions, and on the impact of new technologies. Data from the cardiac surgery registry at the Beth Israel Deaconess Medical Center are presented.
Principal Findings:
Blood conservation strategies such as intraoperative and postoperative salvage, hemodilution and drug treatments to minimize bleeding were developed for cardiac patients. Despite this work, there is significant variation in transfusion practices among cardiac surgery centers. Improved donor selection and screening by increasingly sophisticated tests have dramatically reduced the risks of transfusion-transmitted disease. However, the increasing acuity and complexity of the condition of patients having surgery, as well as the availability of safer allogeneic blood, have resulted in an increasing number of transfusions to patients undergoing cardiac operations. The majority of patients having open heart surgery receive allogeneic blood. Blood conservation strategies continue to be important because of the non-infectious hazards of transfusion such as mistransfusion, transfusion-related acute lung injury, circulatory overload and others. Newer technologies (such as minimally invasive and off-pump surgery) promise to favourably affect blood use.
Conclusion:
Issues such as the cost of blood, limited availability and the potentially harmful effects of transfusion dictate continued research and the development of methods to appropriately minimize transfusion to patients having cardiac surgery.