The object of the study was to retrospectively evaluate protective and risk factors for receiving donor blood products and red cell transfusions after coronary and valve surgery performed with a hollow-fiber oxygenator and with multiple blood-saving techniques. During the period of January 1991 to June 1993, 1310 patients underwent primary coronary and valve surgery using a hollow-fiber oxygenator at our institution; the mean age of this population was 61 ± 10 years; 977 patients were men (74.6%). Of these patients, 73.5% (963/1310) underwent coronary, 21.5% (281/1310) valve, and 5% (66/1310) combined surgery. Two hundred seventy-six (21.1%) needed donor blood product transfusions, while 153 (11.7%) patients underwent red cell transfusions. Significant risk factors for homologous blood product exposure after multivariate logistic regression analysis were, in order of importance: (1) postoperative blood loss (O.R. = 1.0009 per mL, p = 0.0000); (2) cardiopulmonary bypass (CPB) time (O.R. = 1.008 per min, p = 0.0001); (3) age at intervention (O.R. = 1.031 per calendar year, p = 0.0026); and (4) reoperation for bleeding (O.R. = 1.71, p = 0.0078). Protective factors were: (1) male gender (O.R. = 0.56, p = 0.0000); (2) preoperative withdrawal of autologous blood (O.R. = 0.66, p = 0.0016); and (3) a preoperative hematocrit greater than 34% (O.R. = 0.76, p = 0.005). When considering risk factors only for donor red cell exposure, multivariate regression analysis identified the following risk factors: (1) reoperations for bleeding (O.R. = 2.04, p = 0.0002); (2) postoperative blood losses (O.R. = 1.0007 per mL, p = 0.0005); (3) CPB time (O.R. = 1.0075 per min, p = 0.0008); and (4) age at intervention (O.R. = 1.03 per calendar year, p = 0.0160). Protective factors were: (1) intraoperative 'high-dose' aprotinin administration (O.R. = 0.61, p = 0.0024); and (2) preoperative donation if autologous blood (O.R. = 0.65, p = 0.0093); and (3) intraoperative withdrawal of autologous blood by phlebotomy (O.R. = 0.67, p = 0.0114). Applying multiple blood-saving techniques, coronary and valve procedures can now be performed with a low incidence of postoperative donor blood products and red cells exposures; autologous blood predonation and aprotinin administration were highly effective in reducing postoperative transfusion needs.
|Number of pages||9|
|Journal||Journal of Cardiac Surgery|
|Publication status||Published - 1995|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine