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Kojima T, Uhara K, Mori J. Health Consequences of Thymus Removal in Adults. N Engl J Med 2023; 389:1724. [PMID: 37913513 DOI: 10.1056/nejmc2310640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
| | - Koji Uhara
- Itabashi Chuo Medical Center, Tokyo, Japan
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2
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Kaveshnikov VS, Kuzmichkina MA, Serebryakova VN. Predictors of Long-Term Outcomes after Surgical Myocardial Revascularization. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2023. [DOI: 10.20996/1819-6446-2022-12-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
High mortality from cardiovascular diseases (CVD) requires improved approaches to the treatment of this socially significant pathology. Wide implementation of surgical myocardial revascularization makes it possible to improve significantly both life quality and expectancy in patients with coronary heart disease. The aim of this work was to analyze the literature on the impact of preoperative, operative and postoperative factors on the long-term prognosis after coronary artery bypass grafting (CABG). The review refers to both recent and earlier informative works. The target groups for this article are therapists, cardiologists, rehabilitologists, who work with patients in the short and long term after CABG. Data of Russian and foreign literature show that the long-term prognosis after CABG is largely determined by preoperative factors, in particular – age, set of cardiovascular risk factors (RF) and comorbidity, specifically – severity of coronary and systemic atherosclerosis, incident cardiovascular complications, structural and functional state of the heart. In the aggregate these factors reflect the cumulative effect and further potential of actual cardiovascular RFs, affect longterm risk of adverse events, and determine the therapeutic targets of secondary prevention. Priority of arterial conduits and completeness of revascularization are the main operative factors that determine the course of the long-term period after CABG. Among the postoperative factors, the efficiency of secondary CVD prevention is of paramount importance, in particular – achievement of target RF levels, compensation of cardiac and extracardiac pathology, adherence to the long-term medical therapy, known to improve outcomes based on specific comorbidity. Efficiency of secondary CVD prevention largely depends on patient's health attitudes, the key influence on which beyond attending physician can be provided by participation in rehabilitation programs, teaching patients the meaning and essentials of lifestyle modification and cardiovascular RFs’ control.
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Affiliation(s)
- V. S. Kaveshnikov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
| | - M. A. Kuzmichkina
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
| | - V. N. Serebryakova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
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Davierwala PM, Verevkin A, Bergien L, von Aspern K, Deo SV, Misfeld M, Holzhey D, Borger MA. Twenty-year outcomes of minimally invasive direct coronary artery bypass surgery: The Leipzig experience. J Thorac Cardiovasc Surg 2023; 165:115-127.e4. [PMID: 33757682 DOI: 10.1016/j.jtcvs.2020.12.149] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/10/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Minimally invasive direct coronary artery bypass (MIDCAB) surgery involving left anterior descending coronary artery grafting with the left internal thoracic artery through a left anterior small thoracotomy is being routinely performed in some specified centers for patients with isolated complex left anterior descending coronary artery disease, but very few reports regarding long-term outcomes exist in literature. Our study was aimed at assessing and analyzing the early and long-term outcomes of a large cohort of patients who underwent MIDCAB procedures and identifying the effects of changing trends in patient characteristics on early mortality. METHODS A total of 2667 patients, who underwent MIDCAB procedures between 1996 and 2018, were divided into 3 groups on the basis of the year of surgery: group A, 1996-2003 (n = 1333); group B, 2004-2010 (n = 627) and group C, 2011-2018 (n = 707). Groupwise characteristics and early postoperative outcomes were compared. Long-term survival for all patients was analyzed and predictors for late mortality were identified using Cox proportional hazards methods. RESULTS The mean age was 64.5 ± 10.9 years and 691 (25.9%) patients were female. Group C patients (log EuroSCORE I = 4.9 ± 6.9) were older with more cardiac risk factors and comorbidities than groups A (log EuroSCORE I = 3.1 ± 4.5) and B (log EuroSCORE I = 3.5 ± 4.7). Overall and groupwise in-hospital mortality was 0.9%, 1.0%, 0.6%, and 1.0% (P = .7), respectively. Overall 10-, 15-, and 20-year survival estimates for all patients were 77.7 ± 0.9%, 66.1 ± 1.2%, and 55.6 ± 1.6%, respectively. CONCLUSIONS MIDCAB can be safely performed with very good early and long-term outcomes. In-hospital mortality remained constant over the 22-year period of the study despite worsening demographic profile of patients.
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Affiliation(s)
- Piroze M Davierwala
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany.
| | - Alexander Verevkin
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany
| | - Laura Bergien
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany
| | | | - Salil V Deo
- North East Ohio VA Healthcare System, Louis Stokes Cleveland VA Medical Center, Department of Veterans Affairs, Cleveland, Ohio
| | - Martin Misfeld
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany
| | - David Holzhey
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany
| | - Michael A Borger
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany
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Morjan M, Mestres CA, Lavanchy I, Gerçek M, Van Hemelrijck M, Sromicki J, Vogt P, Reser D. The impact of age and sex on in-hospital outcomes in acute type A aortic dissection surgery. J Thorac Dis 2022; 14:2011-2021. [PMID: 35813713 PMCID: PMC9264052 DOI: 10.21037/jtd-21-1863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/24/2022] [Indexed: 12/26/2022]
Abstract
Background Older age and female sex are thought to be risk factors for adverse outcomes after repair of acute type A aortic dissection (AAAD). The aim of this study is to analyze age- and sex-related outcomes in patients undergoing AAAD repair. Methods Retrospective analysis of patients undergoing emergency AAAD repair. Patients were divided in Group A, patients aged ≥75 years and Group B <75. Intraoperative and postoperative data were compared between groups before and after propensity score matching. Sex differences were analyzed by age group. Results Between January 2006 and December 2018, 638 patients underwent emergency AAAD repair. Group A included 143 patients (22.4%), Group B 495 (77.6%). More patients in Group A presented with circulatory collapse (Penn C 26.6% vs. 9.7%, P=0.001) while Group B presented with circulatory collapse-branch malperfusion (Penn BC 29.3% vs. 15.4% P=0.001). After propensity score matching, Group B patients received more complex aortic root (33.6% vs. 23.2%, P=0.019) and concomitant bypass surgery (12.3% vs. 6.3%, P=0.042). There was no significant difference in in-hospital mortality between age groups (18% vs. 12% P=0.12). In Group B, in-hospital mortality was significantly higher in females (22.2% vs. 8.2%, P=0.028). Differences in mortality disappeared after the age of 75 (18.3% vs. 19.4% P=0.87). Conclusions Morbidity and mortality are comparable between patients under and over 75 years after AAAD repair. Female patients <75 had higher in-hospital mortality than their male counterparts.
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Affiliation(s)
- Mohammed Morjan
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.,Clinic for Cardiovascular Surgery, Heart Center Duisburg, Duisburg, Germany
| | - Carlos A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Isabel Lavanchy
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Mustafa Gerçek
- Clinic for Cardiovascular Surgery, Heart Center Duisburg, Duisburg, Germany
| | | | - Juri Sromicki
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Paul Vogt
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Diana Reser
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.,Herzklinik Hirslanden, Zürich, Switzerland
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Marin-Cuartas M, Sá MP, Torregrossa G, Davierwala PM. Minimally invasive coronary artery surgery: Robotic and nonrobotic minimally invasive direct coronary artery bypass techniques. JTCVS Tech 2021; 10:170-177. [PMID: 34984377 PMCID: PMC8691906 DOI: 10.1016/j.xjtc.2021.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/08/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michel Pompeu Sá
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, Pa
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pa
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, Pa
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pa
| | - Piroze M. Davierwala
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Tran L, Greiff G, Wahba A, Pleym H, Videm V. Relative impact of red blood cell transfusion and anaemia on 5-year mortality in cardiac surgery. Interact Cardiovasc Thorac Surg 2021; 32:386-394. [PMID: 33346352 DOI: 10.1093/icvts/ivaa266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/04/2020] [Accepted: 10/06/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim was to compare the relative effects of red blood cell (RBC) transfusion and preoperative anaemia on 5-year mortality following open-heart cardiac surgery using structural equation modelling. We hypothesized that patient risk factors associated with RBC transfusion are of larger importance than transfusion itself. METHODS This prospective cohort study, part of the Cardiac Surgery Outcome Study at St. Olavs University Hospital, Trondheim, Norway, included open-heart on-pump cardiac surgery patients operated on from 2000 through 2017 (n = 9315). Structural equation modelling, which allows for intervariable correlations, was used to analyse pathway diagrams between known risk factors and observed mortality between 30 days and 5 years postoperatively. Observation times between 30 days and 1 year, and 1-5 years postoperatively were also compared with the main analysis. RESULTS In a simplified model, preoperative anaemia had a larger effect on 5-year mortality than RBC transfusion (standardized coefficients: 0.17 vs 0.09). The complete model including multiple risk factors showed that patient risk factors such as age (0.15), anaemia (0.10), pulmonary disease (0.11) and higher creatinine level (0.12) had larger effects than transfusion (0.03). Results from several sensitivity analyses supported the main findings. The models showed good fit. CONCLUSIONS Preoperative anaemia had a larger impact on 5-year mortality than RBC transfusion. Differences in 5-year mortality were mainly associated with patient risk factors.
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Affiliation(s)
- Long Tran
- Department of Clinical and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Cardiothoracic Anaesthesia and Intensive Care, St. Olavs University Hospital, Trondheim, Norway
| | - Guri Greiff
- Department of Cardiothoracic Anaesthesia and Intensive Care, St. Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Alexander Wahba
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiothoracic Surgery, St. Olav's University Hospital, Trondheim, Norway
| | - Hilde Pleym
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Anaesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
| | - Vibeke Videm
- Department of Clinical and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Immunology and Transfusion Medicine, St. Olavs University Hospital, Trondheim, Norway
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Holmgren A, Enger TB, Näslund U, Videm V, Valle S, Evjemo KJD, Friberg Ö, Wahba A. Long-term results after aortic valve replacement for bicuspid or tricuspid valve morphology in a Swedish population. Eur J Cardiothorac Surg 2021; 59:570-576. [PMID: 33179723 PMCID: PMC8043765 DOI: 10.1093/ejcts/ezaa348] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Anders Holmgren
- Heart Centre and Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Tone Bull Enger
- Clinic of Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Ulf Näslund
- Heart Centre and Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Vibeke Videm
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Immunology and Transfusion Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Solveig Valle
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Karen Julie Dybvad Evjemo
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Örjan Friberg
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alexander Wahba
- Heart Centre and Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden.,Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiothoracic Surgery, St. Olavs University Hospital, Trondheim, Norway
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Sex and gender differences in anesthesia: Relevant also for perioperative safety? Best Pract Res Clin Anaesthesiol 2020; 35:141-153. [PMID: 33742574 DOI: 10.1016/j.bpa.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022]
Abstract
Sex (a biological determination) and gender (a social construct) are not interchangeable terms and both impact perioperative management and patient safety. Sex and gender differences in clinical phenotypes of chronic illnesses and risk factors for perioperative morbidity and mortality are relevant for preoperative evaluation and optimization. Sex-related differences in physiology, as well as in pharmacokinetics and pharmacodynamics of anesthetic drugs may influence the anesthesia plan, the management of pain, postoperative recovery, adverse effects, patient satisfaction, and outcomes. Further studies are needed to characterize outcome differences between men and women in non-cardiac, cardiac, and transplantation surgery in order to individualize perioperative management and improve patient safety. Transgender patients represent a vulnerable population who need special perioperative care. Gender balance increases team performance and may improve perioperative outcomes.
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Nuru A, Weltzien JAH, Sandvik L, Tønnessen T, Bjørnstad JL. Short- and long-term survival after isolated coronary artery bypass grafting, the impact of gender and age. SCAND CARDIOVASC J 2019; 53:342-347. [PMID: 31321989 DOI: 10.1080/14017431.2019.1646430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives. Assess the short- and long-term survival for patients who underwent isolated coronary artery bypass grafting (CABG) and evaluate the impact of gender and age. Furthermore to assess the long-term survival in the CABG group compared to the general population. Design. This study included 4044 consecutive patients who underwent isolated CABG at Oslo University Hospital, Ullevål, in Oslo, Norway in the time period from 01 January 2003 to 31 December 2015. Patient data was collected retrospectively from the quality register at the department. Information on survival status was obtained from the Norwegian National Registry. Life expectancy data for the general population was gained from Statistics Norway. Results. Female patients were significantly older than male patients at the time of surgery (mean age 67.0 and 63.9 years, respectively, p < .001), and had significantly lower 30-day survival (mortality was 1.4% and 0.6%, respectively, p = .017). Male gender was independently associated with lower long-term survival (p = .0037) in a multivariate analysis. Male patients aged less than 60 years also showed significantly lower long-term survival (SMR = 1.84, 95% CI = 1.49-2.25) compared to the age-matched general population. Among patients older than 60 years, survival was similar to survival in the age-matched general population. Conclusions. Survival was excellent for patients undergoing surgery. Despite increased age and operative mortality, female patients had better adjusted long-time survival than male patients. There was lower long-term survival among male patients aged less than 60 compared to the general population. Our findings may help clinicians in selecting appropriate patients for surgery.
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Affiliation(s)
- A Nuru
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J A H Weltzien
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - L Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - T Tønnessen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - J L Bjørnstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
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Gjeilo KH, Stenseth R, Wahba A, Lydersen S, Klepstad P. Long-term health-related quality of life and survival after cardiac surgery: A prospective study. J Thorac Cardiovasc Surg 2018; 156:2183-2190.e2. [DOI: 10.1016/j.jtcvs.2018.05.087] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 05/04/2018] [Accepted: 05/12/2018] [Indexed: 01/14/2023]
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Stammers AH, Tesdahl EA, Mongero LB, Stasko A. Gender and intraoperative blood transfusion: analysis of 54,122 non-reoperative coronary revascularization procedures. Perfusion 2018; 34:236-245. [DOI: 10.1177/0267659118808728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Previous studies have shown that women undergoing isolated coronary artery bypass graft (CABG) surgery have an increased risk for postoperative morbidity and mortality when compared to men. Additionally, recent evidence suggests that blood transfusions are independently associated with an increased risk of adverse outcome. Methods: We evaluated gender differences in the risk of intraoperative red blood cell (RBC) transfusion during CABG surgery. Consecutive, non-reoperative CABG procedures performed across 196 institutions between April 2012 and May 2015 were retrospectively reviewed. Gender differences for intraoperative transfusion were evaluated with a multi-variable binary logistic regression model, adjusting for age, blood volume (Nadler formula to normalize for height and weight), body mass index, procedure acuity, net extracorporeal circuit prime volume, use of autologous priming, first hematocrit (Hct) in the operating room (OR), nadir Hct on cardiopulmonary bypass (CPB), volume added on CPB, ultrafiltration volume, urine output on CPB and procedure duration. Results: Among 54,122 patients (25.3% female), 21.6% (n = 11,701) received a RBC transfusion. Compared to men, female patients were older (66 years vs. 64 years, p<0.001), had lower blood volumes (4.3L vs. 5.6L, p<0.001) and a lower preoperative Hct (32.9% vs. 37.2%, p<0.001). Transfusion rates were three-fold higher in women versus men (45.1% vs. 13.7%, p<0.001). After adjustment for independent predictors of intraoperative transfusion, women remained at increased risk versus men (OR = 1.30, 95%CI = 1.19−1.43). Conclusions: Women have an increased risk of intraoperative RBC transfusion versus men. After adjusting for height and weight, much of this risk is due to gender differences in preoperative Hct and blood volume; however, a residual significant risk remained after adjustment. Perfusion strategies aimed at gender differences may minimize unnecessary transfusions. Future study on the impact of gender on transfusion practice in cardiac surgery is warranted.
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Stammers AH, Mongero LB, Tesdahl E, Stasko A, Weinstein S. The effectiveness of acute normolvolemic hemodilution and autologous prime on intraoperative blood management during cardiac surgery. Perfusion 2017; 32:454-465. [DOI: 10.1177/0267659117706014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Intraoperative blood management during cardiac surgery is a multifaceted process incorporating various interventions directed at optimizing oxygen delivery and enhancing hemostasis. The purpose of this study was to evaluate the effects of acute normovolemic hemodilution (ANH) and autologous priming (AP) on preserving the hematocrit during cardiopulmonary bypass (CPB). Method: Case records from a national registry of adult patients who underwent cardiac surgery between January and October 2016 were reviewed. Groups were determined as follows: ANH, AP, ANH+AP or Neither. Primary endpoint was first the hematocrit on CPB with secondary endpoints of hematocrit drift and red blood cell (RBC) transfusion rate. Results: Eighteen thousand and twenty-four (18,024) consecutive patients were reviewed. The first CPB hematocrit was lowest in the ANH group (26.5%±4.4%) and highest in ANH+AP patients (27.5%±4.8%) (p<0.001). The change in hematocrit was greatest in the ANH group (8.3%±3.9%) compared to both the AP (6.4%±3.8%) and ANH+AP (6.9%±4.1%) groups (p<0.001). Intraoperative RBC transfusions were as follows: ANH 26 (7.8%), AP 2,531 (20.0%), ANH+AP 287 (10.3%) and Neither 592 (26.7%) (p<0.001). Conclusions: Regression results show that the use of ANH will result in the greatest decline in hematocrit values. When combined with AP, higher hematocrits and lower transfusions were seen.
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