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General Thoracic and Cardiovascular Surgery

Erschienen in:

08.03.2023 | Review Article

Perioperative transfusion and long-term mortality after cardiac surgery: a meta-analysis

verfasst von: Kei Woldendorp, Lucy Manuel, Arpit Srivastava, Matthew Doane, Levi Bassin, David Marshman

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 6/2023

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Abstract

Objectives

Cardiac surgical procedures are associated with a high incidence of periprocedural blood loss and blood transfusion. Although both may be associated with a range of postoperative complications there is disagreement on the impact of blood transfusion on long-term mortality. This study aims to provide a comprehensive review of the published outcomes of perioperative blood transfusion, examined as a whole and by index procedure.

Methods

A systematic review of perioperative blood transfusion cardiac surgical patients was conducted. Outcomes related to blood transfusion were analysed in a meta-analysis and aggregate survival data were derived to examine long-term survival.

Results

Thirty-nine studies with 180,074 patients were identified, the majority (61.2%) undergoing coronary artery bypass surgery. Perioperative blood transfusions were noted in 42.2% of patients and was associated with significantly higher early mortality (OR 3.87, p < 0.001). After a median of 6.4 years (range 1–15), mortality remained significantly higher for those who received a perioperative transfusion (OR 2.01, p < 0.001). Pooled hazard ratio for long-term mortality similar for patients who underwent coronary surgery compared to isolated valve surgery. Differences in long-term mortality for all comers remained true when corrected for early mortality and when only including propensity matched studies.

Conclusions

Perioperative red blood transfusion appears to be associated with a significant reduction in long-term survival for patients after cardiac surgery. Strategies such as preoperative optimisation, intraoperative blood conservation, judicious use of postoperative transfusions, and professional development into minimally invasive techniques should be utilised where appropriate to minimise the need for perioperative transfusions.

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Titel: Perioperative transfusion and long-term mortality after cardiac surgery: a meta-analysis
verfasst von: Kei Woldendorp
Lucy Manuel
Arpit Srivastava
Matthew Doane
Levi Bassin
David Marshman
Publikationsdatum: 08.03.2023
Verlag: Springer Nature Singapore
Erschienen in: General Thoracic and Cardiovascular Surgery / Ausgabe 6/2023
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-023-01923-w

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