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Ann Thorac Surg 2002;74:986-987
© 2002 The Society of Thoracic Surgeons

Editorial

Transfusion and outcome in heart surgery

Bruce D. Speiss, MD*a

a Department of Anesthesiology, Virginia Commonwealth University/Medical College of Virginia, Richmond, Virginia, USA

* Address reprint requests to Dr Spiess, Department of Anesthesiology, VCU/MCV, 1200 East Broad Street, Richmond, VA, USA
e-mail: bdspiess@hsc.vcu.edu

The first 20% of the full text of this article appears below.

Blood transfusion is given with the intent of increasing oxygen carrying capacity to tissue, thereby prophylaxing against ischemic tissue damage. Physicians have the best of intentions in applying the therapy, but the decision to transfuse is driven by fear (ie, of not acting, lawsuit, or adverse outcome) and emotion. The transfusion trigger, a particular hemoglobin level of discomfort in the prescribing physician, is not defined by clear physiologic parameters. To date, we do not have a real time monitor of oxygen supply and demand to the microcirculation of the whole body or individual organs. Therefore, physicians make transfusion decisions based upon their past teaching and enculturation. We are encultured to believe that giving blood saves lives, yet there is little data published to support such a conclusion. As a result of the lack of evidence based medicine supporting the transfusion decision, the use of blood products during coronary artery bypass grafting (CABG) surgery varies widely. In one series of over 2000 cases, only 3% of patients were transfused, whereas in others 83% of patients received blood [1, 2]. Which practice is the best, has the better outcomes, least costly, etc.?

In the present issue of The Annals, a pioneering article appears and for the first time examines the long-term consequences of blood transfusion. Over 3000 articles are in the literature delineating the risks of blood transfusion. Some recent and well-done studies have been randomized trials of . . . [Full Text of this Article]




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