Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure.
BACKGROUND
Hemodilutional anemia during cardiopulmonary bypass (CPB) is associated with increased mortality during coronary artery bypass graft (CABG) surgery. The impact of intraoperative red blood cell (RBC) transfusion to treat anemia during surgery is less understood. We examined the relationship between anemia during CPB, RBC transfusion, and risk of low-output heart failure (LOF).


RESULTS
Data were collected on 8004 isolated CABG patients in northern New England between 1996 and 2004. Patients were excluded if they experienced postoperative bleeding or received > or = 3 units of transfused RBCs. LOF was defined as need for intraoperative or postoperative intra-aortic balloon pump, return to CPB, or > or = 2 inotropes at 48 hours. Having a lower nadir HCT was also associated with an increased risk of developing LOF (adjusted odds ratio, 0.90; 95% CI, 0.82 to 0.92; P=0.016), and that risk was further increased when patients received RBC transfusion. When adjusted for nadir hematocrit, exposure to RBC transfusion was a significant, independent predictor of LOF (adjusted odds ratio, 1.27; 95% CI, 1.00 to 1.61; P=0.047).


CONCLUSIONS
In this study, we observed that exposure to both hemodilutional anemia and RBC transfusion during surgery are associated with increased risk of LOF, defined as placement of an intraoperative or postoperative intra-aortic balloon pump, return to CPB after initial separation, or treatment with > or = 2 inotropes at 48 hours postoperatively, after CABG. The risk of LOF is greater among patients exposed to intraoperative RBCs versus anemia alone.
Surgenor
Stephen D
SD
Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756. Stephen.D.Surgenor@Hitchcock.ORG.
DeFoe
Gordon R
GR
Fillinger
Mary P
MP
Likosky
Donald S
DS
Groom
Robert C
RC
Clark
Cantwell
C
Helm
Robert E
RE
Kramer
Robert S
RS
Leavitt
Bruce J
BJ
Klemperer
John D
JD
Krumholz
Charles F
CF
Westbrook
Benjamin M
BM
Galatis
Dean J
DJ
Frumiento
Carmine
C
Ross
Cathy S
CS
Olmstead
Elaine M
EM
O'Connor
Gerald T
GT
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000592:standards / Q000706:statistics & numerical data; D002303:Cardiac Output, Low / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D006400:Hematocrit; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000517:prevention & control; D007423:Intra-Aortic Balloon Pumping; D007431:Intraoperative Complications / Q000209:etiology / Q000628:therapy*; D008281:Maine / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009513:New Hampshire / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D012306:Risk; D065227:Transfusion Reaction; D014707:Vermont / Q000453:epidemiology
D002316:Cardiotonic Agents