Abstract 15812: Impact of Preoperative Anemia on Early and Late Outcomes After Surgical Aortic Valve Replacement
Objectives: Red cell transfusion has been correlated with poor outcomes after open heart surgery. While operative indications for transfusion such as major bleeding may be difficult to modify, low preoperative hemoglobin may be addressed prior to surgery. The purpose of this investigation was to determine the impact of low preoperative hemoglobin on outcomes after surgical aortic valve replacement(AVR).
Methods: From 2008-2012, we performed 1706 AVRs including 570(32%) with concomitant CABG. Acute endocarditis cases were excluded. Data was collected prospectively and analyzed using standard univariate, survival, logistic regression and Cox proportional hazard regression methodologies where appropriate.
Results: 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. Preop anemia was strongly associated with periop blood transfusion (OR2.8 95%CI 2.1-3.8). 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.
Conclusions: 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.
- © 2013 by American Heart Association, Inc.