| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Department of Cardiothoracic Anesthesia (G-3), The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195
(Email: kochc{at}ccf.org).
Ranucci and colleagues [1] support findings from prior investigation in the areas of gender, transfusion, and outcomes after cardiac surgery. The authors report similar outcomes among women and men in terms of in-hospital mortality and intensive care unit stay. In their investigation, the authors demonstrate that transfusion of blood and components are risk factors for both morbid events. It is their conjecture that female gender and small body surface area are ultimately related to intraoperative hemodilution and this, in turn, is the trigger for transfusion, or the determinant of adverse outcomes in their investigation.
The authors focus on two important areas of investigation in cardiac surgery: (1) women and (2) transfusion. Although we can not change gender, we recognize that women and men have significantly different preoperative profiles. Clinicians can however change indications to transfuse patients recognizing that transfusion decisions are complicated. What can we take away from the investigation? First, when risk-adjustment is properly performed, women and men have similar outcomes. Second, transfusion is a common occurrence in cardiac surgery and this investigation offers further support that it is associated with higher risk.
From this study, it may be difficult to discern the biologic plausibility of risk plainly associated with transfusion; transfused patients may have simply been "sicker" and no serious relationship can be deduced between transfusion and outcome, as this was not a randomized trial. Certainly, "process of care" factors come into play that are unmeasured and may relate to transfusion decisions in specific patients. We are unable to differentiate patients who received 1 to 2 unit transfusions (amounts not typically associated with catastrophic intraoperative events) from those that received a massive transfusion, as transfusion was examined as a binary variable (yes or no). In addition, there is no way to ascertain a dose-dependent relationship between increasing red cell units and outcome from this investigation. Finally, there are mitigating, unmeasured factors that may impact outcomes, such as accounting for leukocyte reduction or age of red cell units.
The risk-benefit analysis of transfusion is complex. There are probably patients who benefit; however, we are uncertain under what conditions it is beneficial. Our ultimate goal with transfusion is to increase tissue oxygenation, as of yet this is difficult to prove. Recent laboratory work reporting on the impact of reduced levels of nitric oxide in stored blood may lend some biological plausibility to some observed adverse morbid outcomes. However, to better understand the interplay between red blood cell transfusion, tissue oxygenation, and outcomes will require further investigation in the form of prospectively designed trials.
 |
References |
|---|
 Top References |
|---|
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
