Ricardo O. Escárcega, MD, Michael J. Lipinski, MD, PhD, Marco A. Magalhaes, MD, Nevin C. Baker, DO, Sa’ar Minha, MD, Petros G. Okubagzi, MD, Rebecca Torguson, MPH, Fang Chen, PhD, Itsik Ben-Dor, MD, Lowell F. Satler, MD, Augusto D. Pichard, MD,and Ron Waksman, MD
The authors analyzed data retrospectively from 332 patients at a single urban center undergoing a high-risk cardiac surgery – transcatheter aortic valve implantation [TAVI]. TAVI is described as a procedure reserved for high-risk surgical patients or for those deemed inoperable. It is not unsurprising, therefore that almost all met the WHO definition for anemia. They examined the relationships between anemia, bleeding and blood transfusions on patient outcomes. Both short-term and long-term mortality were considered. Their results indicate an increased 30-day all-cause mortality in patients receiving blood transfusions. (This was contrasted with a 2001 study showing the opposite.) They could not show a direct, independent relationship between anemia or bleeding complications and mortality. However, in patients that did experience post-op bleeding, those receiving blood transfusion as part of their treatment had a higher 30-day mortality rate (approx. 18%) than those who did not (approx. 2%). Whether this was attributable to severity of bleeding complication was not clearly addressed. The necessity of tackling pre-op anemia should be heightened, if only to reduce the likelihood of ‘triggering’ a transfusion post-op, which this study relates to increased patient mortality. It was noted that, while generally a greater tendency to transfuse patients with lower hemoglobin levels exists, routine use of blood transfusion to maintain arbitrary hemoglobin levels is not optimal. This study helps further narrow the field of cardiac-related conditions in which one may try to justify transfusion of blood products.
Oshuare Aregbeyen, MD
Clinical Research Coordinator
Anesthesia Research Dept.
Englewood Hospital and Medical Center
350 Engle Street
Englewood, NJ 07631