title: Management of blood transfusion in aortic valve surgery: impact of a blood conservation strategy.
abstract: BACKGROUND
  There are limited data in the literature concerning the effect of a blood conservation strategy (BCS) on aortic valve replacement (AVR) patients.
  
  
  METHODS
  From 2007 to 2011, 778 patients underwent AVR at a single institution. During this period, a multidisciplinary BCS was initiated with emphasis on limiting intraoperative hemodilution, tolerance of perioperative anemia, and blood management education for the cardiac surgery care providers.
  
  
  RESULTS
  Mortality was 3.0% (23 of 778) overall and 1.7% (9 of 522) for isolated first-time AVR. There was no difference in rates of mortality (p = 0.5) or major complications (p = 0.4) between the pre-BCS and post-BCS groups; however, the BCS was associated with a lower risk of major complications (odds ratio, 1.7; p = 0.046) by multivariable analysis. The incidence of red blood cell (RBC) transfusion decreased from 82.9% (324 of 391) to 68.0% (263 of 387; p < 0.01). Of those patients who did not receive any day-of-operation RBC transfusions, 64.5% (191 of 296) did not receive any postoperative RBC transfusions. Lower risk of RBC transfusion was associated with isolated AVR (p < 0.01), a minimally invasive approach (p < 0.01), and BCS (p < 0.01), whereas a greater risk of RBC transfusion was associated with older age (p < 0.01), prior cardiac operation (p = 0.01), female sex (p < 0.01), and smaller body surface area (p < 0.01). Day-of-operation RBC transfusion of 2 units or more was associated with increased deaths (p = 0.01), prolonged intubation (p < 0.01), postoperative renal failure (p = 0.01), and increased incidence of any complication (p < 0.01).
  
  
  CONCLUSIONS
  Perioperative BCS reduced RBC transfusion in AVR patients without an increase in mortality or morbidity. Guidelines for BCS in routine cardiac operations should be extended to AVR patients.
authors.affiliation: Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: David W
authors.initials: DW
authors.lastname: Yaffee
authors.affiliation: Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Deane E
authors.initials: DE
authors.lastname: Smith
authors.affiliation: Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ursomanno
authors.affiliation: Department of Extracorporeal Services, New York University Langone Medical Center, New York, New York.
authors.forename: Fredrick T
authors.initials: FT
authors.lastname: Hill
authors.affiliation: Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Aubrey C
authors.initials: AC
authors.lastname: Galloway
authors.affiliation: Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Abe
authors.initials: A
authors.lastname: DeAnda
authors.affiliation: Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York. Electronic address: eugene.grossi@nyumc.org.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D057668:Bloodless Medical and Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: 16; AVR; BCS; BSA; CABG; COPD; CPB; FFP; OR; RBC; SCA; SD; STS; Society of Cardiovascular Anesthesiologists; The Society of Thoracic Surgeons; aortic valve replacement; blood conservation strategy; body surface area; cardiopulmonary bypass; chronic obstructive pulmonary disease; coronary artery bypass graft; fresh frozen plasma; odds ratio; red blood cell; standard deviation