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The use of blood and blood components in 1,769 patients undergoing open-heart surgery
Insights
Whole blood and red cell transfusions for open-heart surgery decreased significantly. This reduction in transfusion use is linked to hemodilution and increased coronary artery bypass procedures.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
Background:
- Open-heart surgery historically required substantial blood transfusions.
- Transfusion practices have evolved with advancements in surgical techniques and patient management.
Purpose of the Study:
- To analyze trends in blood transfusion utilization for open-heart operations.
- To identify factors contributing to changes in transfusion requirements.
Main Methods:
- Retrospective analysis of transfusion data for open-heart surgery patients.
- Comparison of transfusion units per patient over different time periods (1969-1971 vs. 1975-1977).
- Correlation of transfusion use with specific surgical procedures, such as coronary artery bypass.
Main Results:
- Transfusion use decreased from over 9 units/patient (1969-1971) to just over 3 units/patient (1975-1977).
- Coronary artery bypass patients (71% in 1977) used an average of 2.6 units, while other open-heart operations averaged 4.7 units.
- Hemodilution and acceptance of lower hematocrit levels (25-30%) are key factors in reduced transfusion needs.
Conclusions:
- Significant reduction in blood transfusion requirements for open-heart surgery observed.
- Increased coronary artery bypass procedures and improved intraoperative management (hemodilution, hematocrit tolerance) are primary drivers.
- Hemostasis was maintained with minimal use of fresh-frozen plasma and platelet concentrates, indicating effective management.
Abstract:
There has been a decrease in the use of whole blood and red cell transfusions during and after open-heart operations in the greater Kansas City area from an average of slightly more than 9 units per patient from 1969 through 1971, to just over 3 units per patient from 1975 through 1977. In 1977, 1,256 patients, or 71% of 1,769 patients, underwent coronary artery bypass exclusively and had an average transfusion utilization of 2.6 units. All other open-heart operations averaged 4.7 units per patient. Hemodilution and the acceptance of hematocrits between 25 and 30% in open-heart operations are probably the main factors responsible for lower transfusion use per patient, while the increased proportion of patients undergoing coronary artery bypass accounts for a further decrease in the average amount of blood used per patient. It is of note that blood transfused to patients having an open-heart operation was not significantly fresher than blood for routine use, yet hemostasis was not a problem as evidenced by the small use of fresh-frozen plasma in 67 patients (3.8%) and platelet concentrates in 42 patients (2.4%).