Aggressive blood conservation in coronary artery surgery: impact on patient care
LoCicero, J.; Massad, M.; Gandy, K.; Sanders, J.H.; Hartz, R.S.; Frederiksen, J.W.; Michaelis, L.L.
Journal of Cardiovascular Surgery 31(5): 559-563
1990
ISSN/ISBN: 0021-9509 PMID: 2229148 Document Number: 349371
Data on 100 consecutive non-emergency coronary artery bypass (CABG) patients were analyzed retrospectively. Sixty-nine patients received no homologous blood (Group I). Thirty-one patients received a total of 118 units of blood products averaging 2.23 units of red cells (Group II). The average red cell transfusion rate for all patients was 0.7 units per patient. The median age for Group I was 61 and Group II was 68 years (p<0.05). The average number of grafts was the same for both (3 per patient) with 75% of Group I and 58% of Group II receiving internal mammary artery (IMA) grafts (p<0.05). Twelve of the Group II patients who received intraoperative transfusions on cardiopulmonary bypass to maintain adequate hemoglobin levels were older and had lower admission hematocrits: 36.+-.0.8% compared to 41 .+-. 0.5% for all other patients (p<0.05). Average postoperative blood loss was 889 .+-. 38 ml for Group I and 1077 .+-. 104 ml for Group II (p<0.05). Increased hemorrhage was correlated with bypass time and IMA use but not with preoperative heparin administration, pre-existing risk factors (diabetes, hypertension, etc.), bleeding time, post-bypass clotting time, age or number of grafts. Two patients in Group II and none in Group I required exploration for excessive postoperative hemorrhage. Mortality rate was 2% (both in Group II, neither transfusion related). Discharge hematocrits were the same for all at 29.4 .+-. 0.4%. Among anemia-related postoperative symptoms, only sinus tachycardia was significantly higher in Group I (20%) compared to Group II (6.5%). Non-anemia-related complications (e.g. supraventricular or ventricular tachycardia, postpericardiotomy syndrome, etc.) were similar. Elective CABG can be performed with an acceptable low transfusion rate (1.18 units/patient). Increased age, female gender, and low admission hematocrit increase transfusion potential; IMA use increases hemorrhage but not transfusion rate. Sinus tachycardia is the only anemia-related perioperative morbidity.