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Risk of massive blood product requirement in cardiac surgery: A large retrospective study from 2 heart centers

Dou Huang1, Changwei Chen1, Yue Ming2

  • 1Department of Anesthesiology and Translational Center, West China Hospital, Sichuan University, Chengdu, Sichuan.

Medicine
|February 1, 2019
PubMed

Insights

Massive red blood cell transfusion (MRT) in cardiac surgery is common, especially after coronary artery bypass grafting (CABG). Identifying patient risk factors for MRT can help reduce blood use in these procedures.

Area of Science:

  • Cardiology
  • Transfusion Medicine
  • Surgical Outcomes

Background:

  • Cardiopulmonary bypass (CPB) in cardiac surgery drives significant red blood cell (RBC) consumption.
  • Massive red blood cell transfusion (MRT), defined as ≥4 units of RBCs, is a critical concern in cardiac procedures.
  • Understanding risk factors for MRT is essential for optimizing blood management strategies.

Purpose of the Study:

  • To identify and compare risk factors for MRT in patients undergoing different types of cardiac surgery (valve surgery, coronary artery bypass grafting [CABG], or both) under CPB.
  • To determine if MRT risk factors differ between valve surgery alone and CABG procedures.
  • To inform clinical practice for predicting and managing patients at high risk for MRT.

Main Methods:

  • Retrospective analysis of 8238 patients undergoing valve surgery and/or CABG under CPB at two major Chinese heart centers.
  • Logistic regression (uni- and multivariate) was used to identify risk factors associated with MRT (≥4 units RBCs).
  • Comparison of MRT incidence and risk factors across different surgical groups (valve surgery alone vs. CABG with or without valve surgery).

Main Results:

  • Overall MRT incidence was 21% (1691 patients), with an average of 6.77 ± 4.78 units per patient.
  • The MRT group accounted for 70% of total allogeneic RBC units transfused.
  • MRT incidence was double in CABG patients compared to valve surgery alone patients.
  • Common MRT risk factors included female sex, older age, renal dysfunction, lower BMI, lower preoperative hemoglobin, and longer CPB duration.
  • Specific risk factors for valve surgery included active endocarditis, non-atrial fibrillation, smaller left atrium, abnormal INR, and repeat surgery.

Conclusions:

  • Cardiac surgery types share common MRT risk factors but also have unique predictors.
  • Female sex, older age, renal dysfunction, lower BMI, lower preoperative hemoglobin, and longer CPB are significant MRT risk factors across various cardiac surgeries.
  • Specific factors like endocarditis and repeat surgery increase MRT risk in valve procedures.
  • This research aids in predicting and managing MRT risk in cardiac surgery patients.

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