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Published on: March 14, 2017
The effect on long-term survival of erythrocyte transfusion given for cardiac valve operations
Milo Engoren1, Robert H Habib, Jonathan Hadaway
1Department of Anesthesiology, Yvonne Viens, SGM, Research Institute, St Vincent Mercy Medical Center, Toledo, Ohio 43608, USA. engoren@pol.net
Insights
Perioperative blood transfusions increase mortality after combined valve and coronary artery bypass grafting (CABG) surgery. However, transfusions showed no effect on death rates for isolated valve operations, indicating disease-dependent transfusion impacts.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Outcomes Research
Background:
- Perioperative blood transfusions are linked to increased long-term mortality in coronary artery bypass grafting (CABG) patients.
- Transfusion effects on mortality may vary by disease, with some studies showing no effect or even reduced mortality in other populations.
Purpose of the Study:
- To investigate the impact of perioperative blood transfusions on mortality in patients undergoing valve operations, with or without concurrent CABG.
- To determine if the association between transfusion and mortality differs between isolated valve operations and combined valve and CABG procedures.
Main Methods:
- Retrospective analysis of 1823 patients undergoing valve operations (isolated or with CABG) between 1991 and 2007.
- Logistic regression for 30-day mortality and Cox models for long-term mortality were used.
- Propensity analysis controlled for factors influencing transfusion decisions and patient acuity.
Main Results:
- Transfusion was associated with increased 30-day and long-term mortality exclusively in patients who underwent combined valve and CABG operations.
- No significant association between transfusion and mortality was observed in patients undergoing isolated valve operations.
- The overall mortality at 30 days was 6.9%, and at follow-up was 39%.
Conclusions:
- Blood transfusion does not impact mortality rates following isolated valve operations.
- Transfusion is associated with increased mortality when valve operations are combined with CABG surgery.
- The findings highlight a disease-specific effect of perioperative blood transfusions on surgical outcomes.
Background:
Studies in patients undergoing coronary artery bypass grafting (CABG) have shown an increased long-term mortality rates associated with perioperative blood transfusions. However, some studies in other patient populations have shown no effect on death or even a lowered mortality rate in patients receiving blood transfusions, which suggests that the effects of blood transfusion may be disease-dependent.
Methods:
Data of all patients who underwent valve operations with or without associated CABG between October 2, 1991, and November 14, 2007, were obtained from the department's database and analyzed using logistic regression for 30-day and Cox models for long-term mortality to determine the effects of transfusion on death. To control for the potential interaction between transfusion and complications and sicker patients being more likely to receive blood, we separately analyzed the data for the different valve populations and used propensity analysis to control for sicker patients being more likely to receive blood.
Results:
Of 1823 patients who underwent valve operations, the operation was isolated in 993 and combined with CABG in 830. By 30 days, 125 patients (6.9%) had died, and 717 (39%) were dead at follow-up. After controlling for type of operation and factors that influenced the transfusion decision, transfusion was associated with increased death only in patients who had combined valve and CABG, and not in isolated valve operations.
Conclusions:
Transfusion had no effect on the mortality rate after isolated valve operations but was associated with increased mortality when valve operations were combined with CABG.
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