Seminars in Thoracic and Cardiovascular Surgery
May 22, 2019
Predicting Transfusions During Left Ventricular Assist Device Implant: Peri-Operative Transfusions with LVAD Implantation
Miller, R. J., Gregory, A. J., Kent, W., Banerjee, D., Hiesinger, W., Clarke, B.
OBJECTIVE: Perioperative bleeding and transfusion cause morbidity and mortality in patients receiving left ventricular assist devices (LVADs). We assessed factors associated with transfusions within 30 days of durable LVAD implantation and the clinical outcomes associated with transfusions. METHODS: A retrospective cohort study of patients undergoing initial durable LVAD implantation between 2014 and 2016 was performed. Rates of packed red blood cell (PRBC) or other blood product transfusions (platelets or fresh frozen plasma [FFP]) were asssessed. Ordinal multivariable regression analysis was performed to determine factors independently associated with transfusion. RESULTS: Analysis included 156 patients, mean age 54.6 years and 74.4% male, who received a mean of 11.7 units of PRBC and 10.0 units of other products within 30-days. Pre-implant mechanical ventilation, dialysis, higher INR, previous sternotomy, higher model for end-stage liver disease score and lower hemoglobin were associated with increased PRBC transfusion rates. Higher pre-operative central venous pressure (CVP), mechanical ventilation, concomitant surgical procedures, previous sternotomy, and lower hemoglobin were associated with increased PRBC transfusion rates within 48 hours of implant (adjusted OR 1.46, p=0.013 per 5mmHg). There were no significant associations with ferritin (adjusted OR 1.00, p=0.236) or transferrin saturation (adjusted OR 1.17, p=0.068) . Transfusions were associated with an increase in ventilation duration, intensive care unit length of stay, re-operation for bleeding and all-cause mortality. CONCLUSIONS: In patients undergoing LVAD implantation, peri-operative blood product exposure is common and associated with increased morbidity and mortality. Elevated CVP and anemia are potentially modifiable factors associated with increased early PRBC transfusion rates.