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Risk Factors of Red Blood Cell Transfusion in Isolate off Pump Coronary Artery Bypass Surgery
Eui Suk Chung1, Kay-Hyun Park, Cheong Lim
1Department of Thoracic and Cardiovascular Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Korea.
Insights
Off-pump coronary artery bypass (OPCAB) surgery can reduce red blood cell (RBC) transfusions. Identifying risk factors like low hematocrit and clopidogrel use can further minimize transfusions, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Perioperative red blood cell (RBC) transfusion is associated with adverse outcomes.
- Bloodless cardiac surgery, including off-pump coronary artery bypass (OPCAB), is gaining attention to mitigate transfusion risks.
- Risk factors for RBC transfusion in OPCAB procedures require further investigation.
Purpose of the Study:
- To identify patient- and surgical-specific risk factors for RBC transfusion during OPCAB.
- To evaluate the impact of RBC transfusion on clinical outcomes in OPCAB patients.
Main Methods:
- Retrospective analysis of 113 patients undergoing isolated OPCAB.
- Transfusion threshold set at 28.0% hematocrit.
- Multivariate analysis to determine risk factors for RBC transfusion.
Main Results:
- 47.5% of patients received RBC transfusion (mean 2.2±3.2 units).
- No significant difference in mortality or major complications between transfusion and no-transfusion groups.
- No-transfusion group showed reduced ventilator support, ICU stay, and hospitalization (p<0.05).
- Preoperative low hematocrit (<37.5%) and clopidogrel use were patient risk factors.
- Longer graft harvesting (>75 min) and total operation time (>5.5 hours) were surgical risk factors.
Conclusions:
- OPCAB can be performed without transfusion in over 40% of cases, adhering to transfusion guidelines.
- Major clinical outcomes were comparable between transfusion and non-transfusion groups.
- Understanding and addressing identified risk factors can increase the proportion of OPCAB patients avoiding transfusion.
Background:
Perioperative transfusion of red blood cell (RBC) may cause adverse effects. Bloodless-cardiac surgery has been spotlighted to avoid those problems. Off pump coronary artery bypass (OPCAB) surgery can decrease the transfusion. However, the risk factors of transfusions in OPCAB have not been investigated properly.
Materials And Methods:
One hundred and thirteen patients (male:female=35:78, mean age=66.7±9.9 years) who received isolated OPCAB were retrospectively analyzed from March 2006 to September 2007. The threshold of RBC transfusion was 28.0% of hematocrit. Bilateral internal thoracic arteries graft were used for 99 patients (87.6%). One hundred and three (91.1%) and 35 patients (31.5%) took aspirin and clopidogrel just before surgery.
Results:
Sixty-five patients (47.5%) received the RBC transfusion (mean 2.2±3.2 units). Mortality and major complications were not different between transfusion and no-transfusion group. But, ventilator support time, intensive care unit stay and hospitalization period had been reduced in no-transfusion group (p<0.05). In multivariate analysis, patients risk factors for RBC transfusion were preoperative low hematocrit (<37.5%) and clopidogrel medication. Surgical risk factors were longer graft harvesting time (>75 minutes) and total operation time (>5.5 hours, p<0.05).
Conclusion:
We performed the transfusion according to transfusion guideline; over 40% cases could conduct the OPCAB without transfusion. There were no differences in major clinical results between transfusion and non-transfusion group. In addition, when used together with accurate understanding of transfusion risk factors, it is expected to increase the proportion of patients that do not undergo transfusions.
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