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Ann Thorac Surg 2001;71:769-776
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting

Gordon R. DeFoe, CCPa, Cathy S. Ross, MSb, Elaine M. Olmstead, BSa, Stephen D. Surgenor, MDa, Mary P. Fillinger, MDa, Robert C. Groom, CCPc, Richard J. Forest, CCPc, John W. Pieroni, CCPd, Craig S. Warren, CCPe, Mary E. Bogosian, RNg, Charles F. Krumholz, CCPf, Cantwell Clark, MDc, Robert A. Clough, MDe, Paul W. Weldner, MDc, Stephen J. Lahey, MDg, Bruce J. Leavitt, MDf, Charles A.S. Marrin, MB, BSa, David C. Charlesworth, MDd, Peter Marshall, MDe, Gerald T. O’Connor, PhDb, for the Northern New England Cardiovascular Disease Study Group

a Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
b Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire, USA
c Maine Medical Center, Portland, Maine, USA
d Catholic Medical Center, Manchester, New Hampshire, USA
e Eastern Maine Medical Center, Bangor, Maine, USA
f Fletcher Allen Health Care, Burlington, Vermont, USA
g Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Accepted for publication June 14, 2000.

Address reprint requests to Mr DeFoe, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756
e-mail: gordon.defoe{at}hitchcock.org

Background. Cardiac surgery patients’ hematocrits frequently fall to low levels during cardiopulmonary bypass.

Methods. We investigated the association between nadir hematocrit and in-hospital mortality and other adverse outcomes in a consecutive series of 6,980 patients undergoing isolated coronary artery bypass graft surgery. The lowest hematocrit during cardiopulmonary bypass was recorded for each patient. Patients were divided into categories based on their lowest hematocrit. Women had a lower hematocrit during bypass than men but both sexes are represented in each category.

Results. After adjustment for preoperative differences in patient and disease characteristics, the lowest hematocrit during cardiopulmonary bypass was significantly associated with increased risk of in-hospital mortality, intra- or postoperative placement of an intraaortic balloon pump and return to cardiopulmonary bypass after attempted separation. Smaller patients and those with a lower preoperative hematocrit are at higher risk of having a low hematocrit during cardiopulmonary bypass.

Conclusions. Female patients and patients with smaller body surface area may be more hemodiluted than larger patients. Minimizing intraoperative anemia may result in improved outcomes for this subgroup of patients.




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