title: Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative cardiac surgery.
abstract: OBJECTIVE
  Perioperative transfusion has adverse effects in adults undergoing cardiac surgery. We sought to investigate whether greater use of blood and blood products might be an independent predictor of prolonged postoperative recovery, indicated by duration of mechanical ventilation (DMV), after reparative infant heart surgery.
  
  
  METHODS
  Secondary analysis of prospectively collected data from two randomized trials of hematocrit strategy during cardiopulmonary bypass in infant heart surgery to explore the association of DMV with perioperative transfusion and other variables.
  
  
  METHODS
  Tertiary pediatric hospital.
  
  
  METHODS
  Two hundred seventy infants undergoing two ventricle corrective cardiac surgery without aortic arch reconstruction.
  
  
  RESULTS
  In univariable analyses, longer DMV was associated with younger age and lower weight at surgery, diagnostic group, and higher intraoperative and postoperative blood product transfusion (each p < .001). In multivariable proportional hazard regression, longer total support time and greater intraoperative and early postoperative blood products per kg were the strongest predictors of longer DMV. Patients in the highest tertile of intraoperative blood products per kg had an instantaneous risk of being extubated approximately half that of patients in the lowest tertile (hazard ratio, 0.51; 95% confidence interval, 0.35, 0.73). Patients who received any blood products on postoperative day 1, compared with those who did not, had a hazard ratio for extubation of 0.65 (95% confidence interval, 0.50, 0.85).
  
  
  CONCLUSIONS
  In this exploratory secondary analysis of infants undergoing two ventricular repair of congenital heart disease without aortic arch obstruction, greater intraoperative and early postoperative blood transfusion emerged as potential important risk factors for longer DMV. Future prospective clinical trials are needed to determine whether reduction in blood product administration hastens postoperative recovery after infant heart surgery.
authors.affiliation: Pediatric Division of Cardiology, UCSF Children's Hospital, and Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Alaina K
authors.initials: AK
authors.lastname: Kipps
authors.forename: David
authors.initials: D
authors.lastname: Wypij
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.forename: Emile A
authors.initials: EA
authors.lastname: Bacha
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
mesh_terms: D002315:Cardiopulmonary Bypass; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome
references.citation: Pediatr Crit Care Med. 2002 Apr;3(2):148-152
references.pmid: 12780985
references.citation: Pediatr Crit Care Med. 2004 Jan;5(1):63-8
references.pmid: 14697111
references.citation: J Pediatr. 2003 Feb;142(2):123-7
references.pmid: 12584531
references.citation: Intensive Care Med. 2007 Aug;33(8):1414-22
references.pmid: 17572875
references.citation: J Card Surg. 2007 Sep-Oct;22(5):373-8
references.pmid: 17803571
references.citation: J Thorac Cardiovasc Surg. 2002 Jan;123(1):110-8
references.pmid: 11782764
references.citation: Crit Care Med. 2006 Jun;34(6):1608-16
references.pmid: 16607235
references.citation: Crit Care Med. 2001 Feb;29(2):227-34
references.pmid: 11246298
references.citation: J Thorac Cardiovasc Surg. 2008 Feb;135(2):347-54, 354.e1-4
references.pmid: 18242267
references.citation: Crit Care Med. 1986 Mar;14(3):211-4
references.pmid: 3943337
references.citation: J Thorac Cardiovasc Surg. 2003 Dec;126(6):1765-74
references.pmid: 14688685
references.citation: Circulation. 1995 Oct 15;92(8):2226-35
references.pmid: 7554206
references.citation: N Engl J Med. 2007 Apr 19;356(16):1609-19
references.pmid: 17442904
references.citation: Ann Thorac Surg. 2002 Oct;74(4):1180-6
references.pmid: 12400765
references.citation: Minerva Anestesiol. 2007 Dec;73(12):615-21
references.pmid: 18046291
references.citation: J Pediatr. 2003 Jul;143(1):67-73
references.pmid: 12915826
references.citation: Pediatr Crit Care Med. 2002 Jul;3(3):269-274
references.pmid: 12780968
references.citation: Paediatr Anaesth. 2006 Nov;16(11):1166-75
references.pmid: 17040306
references.citation: N Engl J Med. 2008 Mar 20;358(12):1229-39
references.pmid: 18354101
references.citation: Ann Thorac Surg. 2009 Jan;87(1):187-97
references.pmid: 19101294
references.citation: J Thorac Cardiovasc Surg. 2005 Sep;130(3):654-61
references.pmid: 16153909
references.citation: Crit Care Med. 2004 Jan;32(1):39-52
references.pmid: 14707558
references.citation: N Engl J Med. 1999 Feb 11;340(6):409-17
references.pmid: 9971864