Transcript Results of the St. Jude Medical TrifectaTM Pericardial

IMPACT OF PREOPERATIVE
ANEMIA ON EARLY AND LATE
OUTCOMES AFTER SURGICAL
AORTIC VALVE REPLACEMENT
Rohan S. Menon BS, Wilson Szeto MD, Kanika Gupta BS, Prashanth
Vallabhajosyula MD, Patrick Moeller BS, William Moser CRNP,
Michael Acker MD, Joseph Bavaria MD, Nimesh Desai MD PhD
Department of Cardiovascular Surgery
University of Pennsylvania, Philadelphia
INTRODUCTION
METHODS
 Red cell transfusion has been correlated  Between 2008-2012, we performed 1706
with poor outcomes after open heart
surgery.
 While some operative indications for
transfusion may be difficult to modify,
low preoperative hemoglobin may be
addressed before surgery.
 The purpose of this investigation was to
determine the impact of low
preoperative hemoglobin on outcomes
after surgical aortic valve replacement
(AVR)
AVRs. 570 (32%) of these cases included
a concomitant CABG procedure.
 Data were analyzed using standard
univariate, survival, logistic regression
methodologies.
 Acute endocarditis cases were excluded.
RESULTS
 Preop anemia was strongly associated
with periop blood transfusion(OR2.8
95%CI 2.1-3.8).
 Among 658 females, anemia (preop
Hgb≤11g/dl) was present in
198(30.1%). Among 1048 males,
anemia (preop Hgb≤12g/dl) was
present in 347(33.1%).
 Multivariate risk factors for preop
anemia included increasing patient
age, diabetes, LV ejection fraction(LV
EF) <40%, chronic renal
insufficiency(CRI) and previous
sternotomy.
 Other risk factors for periop blood
transfusion included: Increasing patient
age, concomitant CABG, female gender,
and previous sternotomy. In a fully
adjusted model, preop anemia was
associated with early mortality(OR1.8,
95%CI 1.2-3.1).
 Other early mortality risk factors
included: Increasing patient age,
concomitant CABG, female gender, LV
EF<40%, CRI and previous sternotomy.
 Preop anemia was also highly
associated with late mortality, log rank
p<0.001.
 Multivariate predictors of late mortality
included; Preoperative anemia (HR1.8
95%CI 1.3-2.5), increasing patient age,
diabetes, LV EF <40%, and CRI.
CONCLUSION
Preoperative anemia is highly associated with
mortality and this effect continues well beyond
the perioperative period.
Strategies aimed at modifying this risk factor
warrant further investigation.