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Published on: August 16, 2021
Blood Product Utilization with Left Ventricular Assist Device Implantation: A Decade of Statewide Data
Mohammed Quader1, Damien J LaPar, Luke Wolfe
1From the *Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; †University of Virginia, Charlottesville, Virginia; ‡Virginia Cardiac Surgery Quality Initiative, Washington, District of Columbia; and §Cardiac, Vascular and Thoracic Surgery Associates, Falls Church, Virginia.
Insights
Blood transfusions remain high for left ventricular assist device (LVAD) implantation, but the total units transfused decreased over the decade studied. This indicates a potential shift in transfusion practices for these complex cardiac surgeries.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Medical Device Implantation
Background:
- Declining blood transfusion rates are observed in cardiac surgery.
- Trends in blood product utilization for left ventricular assist device (LVAD) implantation are not well-established.
- LVAD implantation is a complex procedure often associated with significant bleeding risks.
Purpose of the Study:
- To investigate blood transfusion trends in patients undergoing LVAD implantation over a 10-year period.
- To identify factors associated with blood product use during LVAD surgery.
- To analyze changes in the volume of blood products transfused over time.
Main Methods:
- Retrospective analysis of a statewide database including 666 LVAD implantations from July 2004 to June 2014.
- Examination of intraoperative and postoperative blood product usage (plasma, platelets, RBCs, cryoprecipitate).
- Multivariable analysis to identify preoperative predictors of blood transfusion.
Main Results:
- Blood product utilization remained high, with 92% of patients receiving transfusions.
- Significant reduction in the average units of blood transfused was observed in the latter 5 years (2010-2014) compared to the first 5 years (2005-2009).
- Preoperative factors associated with transfusion included lower hematocrit, lower BMI, reoperative surgery, intraaortic balloon pump use, and nonelective surgery.
Conclusions:
- Blood transfusion remains a frequent occurrence in LVAD implantation.
- While overall transfusion rates are high, there has been a decrease in the quantity of blood products transfused in recent years.
- Identifying predictive factors for transfusion can aid in optimizing perioperative management.
Abstract:
Blood transfusion rates with cardiac surgery over time have decreased, this trend has not been examined for patients undergoing left ventricular assist device (LVAD) implantation. We investigated blood transfusion trends with LVAD implantation in a statewide database. Between July 2004 and June 2014, 666 LVADs were implanted (age 54.5 ± 12.6 years. 77% men). Reoperation for bleeding was required in 22% of cases. Postoperative mortality was 13.2%. Over the decade, use of any blood products with LVAD surgery by year ranged from 83% to 100% (92 ± 5.3%). Intraoperative and postoperative blood products use was 71.8% and 73%, respectively. Only 7.4% of patients did not receive any blood products. Blood transfusion during surgery consisted of plasma (60%), platelets (56%), red blood cells (RBCs) (44.3%), and cryoprecipitate (32%), whereas after surgery RBC use was more frequent (68%). Compared with the initial 5 years (2005-2009), the units of blood transfused in the second 5 years (2010-2014) were significantly less, 21 ± 23 units vs. 16.6 ± 20.5 units, p = 0.0038. By multivariable analysis, preoperative factors predictive of blood transfusion are lower hematocrit, lower BMI, reoperative surgery, requirement for intraaortic balloon pump (IABP), and nonelective surgery. Blood transfusion with LVAD implantation remains very high. However, the amount of blood product transfused has decreased in the last 5 years.
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