Risks associated with the transfusion of various blood products in aortic valve replacement

Abstract

Background: Patients undergoing cardiac operations often require transfusions of red blood cells, plasma, and platelets. From a statistical point of view, there is a significant collinearity between the components, but they differ in indications for use and composition. This study explores the relationship between the transfusion of different blood components and long-term mortality in patients undergoing aortic valve replacement alone or combined with revascularization.

Methods: A retrospective single-center study was performed including 1,311 patients undergoing aortic valve replacement. Patients who received more than 7 units of red blood cells, those who died early (7 days), and emergency cases were excluded. Patients were monitored for up to 9.5 years. A broad selection of potential risk factors were analyzed using Cox proportional hazards regression, where transfusion of red blood cells, plasma, and platelets were forced to remain in the model.

Results: The transfusion of red blood cells was not associated with decreased long-term survival (hazard ratio [HR], 1.01; p = 0.520) nor was the transfusion of platelets (HR, 0.946; p = 0.124); however, the transfusion of plasma was (HR, 1.041; p < 0.001). All HRs are per unit of blood product transfused. No increased risk was found for patients undergoing a combined procedure.

Conclusions: No significant risk for long-term mortality was associated with transfusion of red blood cells during the study period. However, the transfusion of plasma was associated with increased mortality.

Keywords: 18; ALT; AVR; BMI; C-reactive protein; CABG; CCS; CI; COPD; CPB; CRP; Canadian Cardiovascular Society; HR; IABP; ICU; LVEF; MDRD; Modified Diet in Renal Disease; NYHA; New York Heart Association; PCI; PLA; PVD; RBC; RIFLE; TRALI; TRC; alanine aminotransferase; aortic valve replacement; body mass index; cardiopulmonary bypass; chronic obstructive pulmonary disease; confidence interval; coronary artery bypass grafting; eGFR; estimated glomerular filtration rate; hazard ratio; intensive care unit; intraaortic balloon pump; left ventricular ejection fraction; percutaneous coronary intervention; peripheral vascular disease; plasma; platelets; red blood cell; risk-injury-failure-loss-end stage; transfusion-related acute lung injury.