Abstract
Objective: It has become very important to avoid homologous blood transfusions in today's cardiac surgery. We performed a retrospective analysis to find out preoperative factors to predict the risk for transfusion of red-cell concentrate in cardiac surgery. Methods: This study included 400 consecutive patients undergoing coronary artery bypass grafting. We also included emergency (4 %) and re-operations (8 %). We tried to find out predictive factors for the need of transfusion of red-cell concentrate on the base of logistic regression coefficient and the odds ratio. We looked at the following factors as predictors of transfusion risk: left ventricular ejection fraction < 0.35, age over 70 years, preoperative hemoglobin < 11 g/dl, insulin-dependent diabetes (IDDM), emergency operation, female sex, impaired renal function (creatinine > 1.6 mg/dl), and re-operation. Results: In our group, 132 (33 %) patients received transfusion during hospitalization, while 268 (67 %) did not. On average, 2.2 ± 0.68 units of red-cell concentrate were transfused per patient. In addition, we found a predictive value for transfusion for the following parameters: age > 70 years, preoperative hemoglobin < 11 g/dl, re-operation and ejection fraction < 0.35. We could not find any significantly increased blood transfusion risk in female cases, insulin dependent diabetes mellitus, or impaired renal function. Conclusions: We could show that there is normally no need for blood transfusion in ⅔ of the patients in cardiac surgery according to this study's results. Furthermore, it was obvious that some patient variables can be used predict the risk for perioperative transfusion. Based on these results, the prophylactic administration of aprotinin or the use of a cell saver could be useful in se-lected patients.
Key words
Cardiac surgery - blood preservation - bypass surgery
References
-
1
Holland P V.
Post transfusion hepatitis: Current risks and causes.
Vox Sang.
1998;
74
(2)
135-141
-
2
Blumberg N.
Allogeneic transfusion and infection: Economic and clinical implications.
Semin Hematol.
1997;
34
(3)
34-40
-
3
Wagner S.
Transfusion-related bacterial sepsis.
Curr Opin Hematol.
1997;
4
(6)
464-469
-
4
Frere M C, Rapaille A, Bouillenne C. et al .
Analysis of 516 reports of reactions after the transfusion of labile blood products.
Transfus Clin Biol.
2001;
8
(4)
333-343
-
5
Lazzara R R, Kidwell F E, Kraemer M F. et al .
Reduction in costs, blood products and operating time in patients undergoing open heart surgery.
Arch Surg.
1997;
132
(8)
858-861
-
6
Casati V, Guzzon D, Oppizzi M. et al .
Hemostatic effects of aprotinin, tranexamic acid and epsilon-aminocaproic acid in primary cardiac surgery.
Ann Thorac Surg.
1999;
68
(6)
2252-2257
-
7
Bennett-Guerrero E, Sorohan J G, Gurevich M L. et al .
Cost-benefit and efficacy of aprotinin compared with epsilon-aminocaproic acid in patients having repeated cardiac operations: A randomized blinded clinical trial.
Anesthesiology.
1997;
87
(6)
1373-1380
-
8
Dunn C J, Goa K L.
Tranexamic acid: A review of ist use in surgery and other indications.
Drugs.
1999;
57
(6)
1005-1032
-
9
Fergusson D, Blair A, Henry D. et al .
Technologie to minimize blood transfusion in cardiac and orthopedic surgery. Results of a practice variation survey in nine countries. International study of perioperative transfusion (ISPOT) investigators.
Int J Technol Assess Health Care.
1999;
15
(4)
717-728
-
10
Mc G ill, O'Shaugnessy D, Pickering R. et al .
Mechanical methods of reducing blood transfusion in cardiac surgery: Randomized controlled trial.
BMJ.
2002;
1
1299
-
11
Cosgrove D M, Loop F D, Lytle B W. et al .
Determinants of blood utilization during myocardial revascularization.
Ann Thorac Surg.
1985;
40
(4)
380-384
-
12
Ferraris V A, Gildengroin V.
Predictors of excessive blood use after coronary artery bypass grafting. A multivariate analysis.
J Thorac Cardiovasc Surg.
1989;
98
(4)
492-497
-
13
Bilfinger T V, Conti V R.
Blood conservation in coronary artery bypass surgery: Prediction with assistance of a computer model.
Thorac Cardiovasc Surg.
1989;
37
(6)
365-368
-
14
Higgins T L, Estafanous F G, Loop F D. et al .
Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score.
JAMA.
1992;
6
(17)
2344-2348
-
15
Paone G, Spencer T, Silvermann N A.
Blood conservation in coronary artery surgery.
Surgery.
1994;
116
(4)
672-678
-
16
Sandrelli L, Pardini A, Lorusso R. et al .
Impact of autologous blood predonation on a comprehensive blood conservation program.
Ann Thorac Surg.
1995;
59
(3)
730-735
-
17
Daily P O, Lamphere J A, Dembitsky W P. et al .
Effect of prophylactic epsilon-aminocaproic acid on blood loss and transfusion requirements in patients undergoing first-time coronary artery bypass grafting. A randomized, prospective, double-blind study.
J Thorac Cardiovasc Surg.
1994;
108
(1)
99-108
-
18
Roussou J A, Engelmann R M, Flack J E. et al .
Tranexamic acid significantly reduces blood loss associated with coronary revascularization.
Ann Thorac Surg.
1995;
59
(3)
671-675
-
19
Blauhut B, Gross C, Necek S. et al .
Effects of high-dose aprotinin on blood loss, platelet function, fibrinolysis, complement and renal function after cardiopulmonary bypass.
J Thorac Cardiovasc Surg.
1991;
101
(6)
958-967
J. Litmathe
Department of Thoracic- and Cardiovascular Surgery, Heinrich-Heine-University
Moorenstraße 5
40225 Düsseldorf
Germany
