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Transfusion
Infection:
Mortality:
Sternal wound Pulmonary Renal
MSOF Short
Pneumonia dysfunction insufficiency
Long-term
•48% transfused
•Most commonly
1-2 units transfused
•Older, smaller,
lower pre-op HCT,
comorbidity,
clinical presentation:
emergency, NYHA,
preop IABP; reoperation
longer clamp times
Infection:
End-points: bacteremia, septicemia,
superficial and deep sternal wound infections
Banbury, et al., JACC 2006;202:131
•N=15,592
•(55%)
transfused
•Dose-dependent
relationship
• Evidence suggests an
inflammatory mechanism in
development of AF
• RBC: direct infusion of
inflammatory mediators and
augmentation of response to
CBP and CTS
• RBC a/c new onset AF on and
off pump patients
N=5841
Engoren, et al. Annals of Thoracic Surgery 2002
N=1915
N=649
transfused
N=546
Propensity
matched
•Blackstone parametric
decomposition method accounts
for non-proportionality;
simultaneously models time-
N=10,289 varying hazard and risk factors
Koch et al., Annals of Thorac Surg 2006;82:13-20
•Reductions in
functional recovery
paralleled RBC
transfused
• Leukocyte-reduced status
• Blood substitutes
Storage Duration:
Hemorrheological Changes
Journal of Surgical Research 2002;102:6-12
Exclusively blood stored <14 days (orange, N=2872) and >14 days
(blue, 3130). Distributions between 2 groups are similar.
Mean Storage duration and number of RBC units by storage duration.
Dose-response Relationship Between Max Days
Storage and Probability of Composite Outcome
Increasing linear trend, particularly for those receiving units > 14 days storage duration
Storage Duration and Outcome
Survival and Hazard Curves
N=2872 (yellow, younger), N=3130 (blue, older)