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Impact of early massive transfusion and blood component ratios in patients undergoing left ventricular assist device

Yeahwa Hong1, Keith Dufendach2, Yisi Wang3

  • 1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Journal of Cardiac Surgery
|September 24, 2021
PubMed

Insights

Early massive transfusion after left ventricular assist device (LVAD) implantation is linked to worse survival and more complications. Balancing platelet to packed red blood cell (pRBC) transfusions may improve outcomes in massive transfusion patients.

Area of Science:

  • Cardiology
  • Transfusion Medicine
  • Surgical Outcomes

Background:

  • Left ventricular assist device (LVAD) implantation is a critical intervention for advanced heart failure.
  • Massive transfusion protocols and blood product ratios are crucial considerations in complex surgical procedures like LVAD implantation.
  • Understanding the impact of early transfusion strategies on LVAD outcomes is essential for improving patient survival and recovery.

Purpose of the Study:

  • To evaluate the association between early massive transfusion and patient outcomes after LVAD implantation.
  • To determine the effect of different blood component ratios on survival and complications in LVAD recipients.
  • To investigate whether balanced transfusion strategies can mitigate adverse effects of massive transfusion.

Main Methods:

  • Retrospective analysis of adult patients undergoing LVAD implantation from 2009-2018.
  • Stratification of patients into massive and non-massive transfusion groups based on intraoperative and 24-hour postoperative transfusions.
  • Primary outcome: survival; Secondary outcomes: postoperative complications; Sub-analyses: balanced transfusion impact.

Main Results:

  • 45.3% of patients required massive transfusions, associated with higher rates of adverse events (reoperation, renal/hepatic dysfunction) and lower survival rates (30-day, 90-day, 1-year, 2-year, overall).
  • Massive transfusion significantly increased the risk-adjusted mortality rate (HR: 2.402, p < .001).
  • Balanced platelet to packed red blood cell (pRBC) transfusion improved 2-year and overall mortality in the massive transfusion cohort, while balanced fresh frozen plasma to pRBC did not show survival benefits.

Conclusions:

  • Early massive transfusion following LVAD implantation is significantly associated with adverse outcomes and increased mortality.
  • Balancing platelet to pRBC transfusion ratios in the early postoperative period may be a key strategy to improve survival in LVAD patients requiring massive transfusions.
  • Further research into optimized transfusion strategies is warranted to enhance LVAD patient care and long-term prognosis.
Abstract

Keywords:
adverse eventsleft ventricular assist deviceperioperative managementresuscitationsurvivaltransfusion

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