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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Milo C. Engoren Anoar Zacharias Thomas A. Schwann Christopher J. Riordan Samuel J. Durham Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Engoren, M. C. Articles by Durham, S. J. Search for Related Content PubMed Articles by Engoren, M. C. Articles by Durham, S. J. Related Collections Cardiac - pharmacology

Ann Thorac Surg 2003;76:654
© 2003 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Department of Anesthesiology, St. Vincent Mercy Medical Center, 2213 Cherry St, Toledo, OH 43608, USA
^b Department of Cardiovascular Surgery, St. Vincent Mercy Medical Center, 2213 Cherry St, Toledo, OH 43608, USA

e-mail: engoren{at}pol.net

To the Editor:

We appreciate Dr Robinson’s thoughtful comments on our study [1]. The art of medicine should remain alive and well, but it must be based on science. In no way was our study meant to suggest that there is no place for transfusion, but rather that our results indicated that the decision to transfuse should be very carefully weighed and that further investigation is needed to elucidate this issue.

Over the years, the hemoglobin threshold for transfusion has decreased as evidence has accumulated regarding the benefits versus harm of transfusion. Although transfusion may have short-term benefits, which we did not evaluate, we reiterate that we found an association between transfusion and long-term mortality.

As we discussed in the report, our study was not a prospective, randomized one, and therefore, we could not show that transfusion caused the increased mortality or was merely a strong covariate of the true culprit producing the worse long-term outcome. From one perspective, this suggests that transfusion may actually cause the increased mortality and is not just a marker of sicker patients. Alternatively, transfusion may have been beneficial enough that death was delayed; what would have been an early operative death became a late death. The latter would effectively show up as an association between transfusion and increased late mortality.

Perhaps the message from our study is that transfusion—and therefore its precursors—is associated with (and possibly contributes to) late mortality after coronary artery bypass grafting. Future efforts should focus on resolving this important point raised by our data. It will take appropriate prospective, randomized study designs to determine which patients benefit from transfusion and whether or not transfusion causes an increased long-term mortality.

References

1. Engoren M.C., Habib R.H., Zacharias A., Schwann T.A., Riordan C.J., Durham S.J. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg 2002;74:1180-1186.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Milo C. Engoren Anoar Zacharias Thomas A. Schwann Christopher J. Riordan Samuel J. Durham Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Engoren, M. C. Articles by Durham, S. J. Search for Related Content PubMed Articles by Engoren, M. C. Articles by Durham, S. J. Related Collections Cardiac - pharmacology