The Impact Of Blood Transfusion On Survival Following Isolated Aortic Valve Replacement: A Ten Year Follow-up Result
Sam Poon, Sadiq Suhail, Jeremy Chan, Sobaran Sharma, Pankaj Kumar.
Morriston Hospital, SWANSEA, United Kingdom.
OBJECTIVE: : Blood transfusion is common in cardiac surgery and the long term impact remains unclear. We aim to investigate the impact of red blood cells transfusion on survival following aortic valve replacement.
METHODS: A retrospective cohort study on 490 consecutive patients who underwent isolated aortic valve replacement (AVR) from January 2007 to September 2011 was undertaken. The mean duration of follow up was 10 years and the mean age of patients was 69. The overall 10 year survival was analyzed in relation of red blood cells transfusion. A matched propensity score based on logistic regression analysis was performed.
RESULTS: Overall 39% of patients received blood transfusion. The mean pre-operative haemoglobin was 13.2 gm/dL and mean unit of blood transfused was 2 units. Following propensity matching, perioperative blood transfusion was associated with poorer survival in 10 years compared to patients who had no blood transfusion (71.4% vs. 61 %, p<0.001, HR 1.24 95% CI 1.13-1.37, p<0.001). A subgroup analysis on the number of blood units transfusion showed that 1 and 2 units of blood transfusion did not adversely impact on survival but for patients receiving 3-4, and more than 5 units of blood products, there is a positive correlation for significant reduction in 10 years survival. (Hazard ratio (HR) for 3-4 units was 2.0 (95% CI 1.2-3.3, p=0.005) and more than 5 units HR 2.9 ( 95% CI 1.8-4.7, p<0.001).
CONCLUSIONS:Blood transfusion is associated with reduced long term survival following aortic valve replacement. Patients receiving more than 3 units of blood had a significant decrease in survival compared to expected survival. Pre-operative patient optimization may improve long term outcomes by reducing the likelihood of blood transfusion.
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