目的:文献支持接受围手术期红细胞(pRBC)输血的心脏手术患者的相关死亡率增加的断言。当前研究的目的是评估非pRBC血液制品输血与死亡率增加之间是否存在关联。
方法:来自我们中心胸外科医师协会数据库的数据包括2010年至2018年接受心脏手术的患者。排除有pRBC输血或循环停止的患者。进行倾向匹配(1:1;卡尺=倾向评分logit的标准偏差的0.2倍)。使用Kaplan-Meier估计和Cox回归。心脏移植,心室辅助装置,经导管主动脉瓣,并且经历过循环骤停的患者被排除在本分析之外.
结果:共有8042例患者符合分析标准。在倾向匹配(1:1)之后,395例需要围手术期非pRBC血液制品的患者(血小板,新鲜冷冻血浆,和冷沉淀)与395例非输血患者相匹配,产生公平的患者队列。中位随访时间为4.5(3.0-6.4)年。患者接受血小板(327[82.8%]),新鲜冷冻血浆(141[35.7%]),和冷沉淀(60[15.2%])。术后死亡率无显著差异(6[1.5%]vs4[1.0%];P=0.52)。输血组再次手术(20[5.0%]vs8[2.0%];P<.02)和长时间通气(36[9.1%]vs19[4.8%];P<.02)的发生率更高。紧急手术(比值比[OR]2.86[1.72-4.78];P<.001),主动脉内球囊反搏(OR3.24[1.64-6.39];P<.001),和多瓣膜手术(OR4.34[2.83-6.67];P<.001)与血液制品使用显著相关。输血(危险比;1.15[0.89-1.48];P=3)与死亡风险增加无显著相关。队列之间没有显著的长期生存差异。
结论:需要单独使用血液制品进行心脏手术的患者,没有pRBC输血,与不需要血液制品的患者相比,具有相似的术后和长期生存率。这些数据基于有限的患者样本,未来的研究将有助于提高这些结果的普遍性。
The literature supports the assertion that patients undergoing cardiac surgery who receive perioperative packed red blood cell (pRBC) transfusions have increased associated mortality. The aim of the current study is to assess whether there is an association between non-pRBC blood product transfusions and increased mortality.
Data from our center\'s Society of Thoracic Surgeons database included patients who underwent cardiac surgery from 2010 to 2018. Patients with pRBC transfusions or circulatory arrest were excluded. Propensity matching was performed (1:1; caliper = 0.2 times the standard deviation of logit of propensity score). Kaplan-Meier estimates and Cox regression were used. Cardiac transplant, ventricular assist devices, transcatheter aortic valves, and patients who had experienced circulatory arrest were excluded from this analysis.
A total of 8042 patients met criteria for analysis. Following propensity matching (1:1), 395 patients requiring perioperative non-pRBC blood products (platelets, fresh-frozen plasma, and cryoprecipitate) were matched with 395 nontransfusion patients, yielding equitable patient cohorts. Median follow-up was 4.5 (3.0-6.4) years. Patients received platelets (327 [82.8%]), fresh-frozen plasma (141 [35.7%]), and cryoprecipitate (60 [15.2%]). There was no significant difference in the postoperative mortality (6 [1.5%] vs 4 [1.0%]; P = .52). Reoperation (20 [5.0%] vs 8 [2.0%]; P < .02) and prolonged ventilation (36 [9.1%] vs 19 [4.8%]; P < .02) were greater in the transfusion group. Emergent operation (odds ratio [OR] 2.86 [1.72-4.78]; P < .001), intra-aortic balloon pump (OR 3.24 [1.64-6.39]; P < .001), and multivalve operation (OR 4.34 [2.83-6.67]; P < .001) were significantly associated with blood product use. Blood product transfusion (hazard ratio; 1.15 [0.89-1.48]; P = .3) was not significantly associated with increased mortality risk. There was no significant long-term survival difference between cohorts.
Patients who undergo cardiac surgery requiring blood products alone, without pRBC transfusion, have similar postoperative and long-term survival compared with patients not requiring blood products. These data are based on a limited patient sample, and future studies will aid in improving the generalizability of these results.