Management of blood transfusion in aortic valve surgery: Impact of a blood conservation strategy

David W. Yaffee, Deane E. Smith, Patricia A. Ursomanno, Fredrick T. Hill, Aubrey C. Galloway, Abelardo DeAnda, Eugene A. Grossi

Research output: Contribution to journalArticle

19 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)95-101
Number of pages7
JournalAnnals of Thoracic Surgery
Volume97
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

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Bloodless Medical and Surgical Procedures
Erythrocyte Transfusion
Aortic Valve
Blood Transfusion
Mortality
Hemodilution
Body Surface Area
Incidence
Intubation
Thoracic Surgery
Renal Insufficiency
Anemia
Odds Ratio
Guidelines
Morbidity
Education

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Management of blood transfusion in aortic valve surgery : Impact of a blood conservation strategy. / Yaffee, David W.; Smith, Deane E.; Ursomanno, Patricia A.; Hill, Fredrick T.; Galloway, Aubrey C.; DeAnda, Abelardo; Grossi, Eugene A.

In: Annals of Thoracic Surgery, Vol. 97, No. 1, 01.2014, p. 95-101.

Research output: Contribution to journalArticle

Yaffee, David W. ; Smith, Deane E. ; Ursomanno, Patricia A. ; Hill, Fredrick T. ; Galloway, Aubrey C. ; DeAnda, Abelardo ; Grossi, Eugene A. / Management of blood transfusion in aortic valve surgery : Impact of a blood conservation strategy. In: Annals of Thoracic Surgery. 2014 ; Vol. 97, No. 1. pp. 95-101.
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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.",
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T1 - Management of blood transfusion in aortic valve surgery

T2 - Impact of a blood conservation strategy

AU - Yaffee, David W.

AU - Smith, Deane E.

AU - Ursomanno, Patricia A.

AU - Hill, Fredrick T.

AU - Galloway, Aubrey C.

AU - DeAnda, Abelardo

AU - Grossi, Eugene A.

PY - 2014/1

Y1 - 2014/1

N2 - 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.

AB - 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.

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