Graft occlusions caused by transfusions in heart surgery

Is transfusion associated with graft occlusion after cardiac operations?

Engoren M1, Schwann TA2, Jewell E3, Neill S3, Benedict P3, Likosky DS4, Habib RH5.

Abstract

BACKGROUND:

Packed red blood cell (RBC) transfusions are associated with increased mortality after coronary artery bypass grafting (CABG) but not after cardiac valve operations. Transfusions are associated with increased strokes and deep venous thromboses after cardiac operations as well as increased peripheral vascular graft thrombosis. The purpose of this study was to determine if RBC transfusions were associated with a greater hazard of an occluded graft developing after CABG.

METHODS:

Patients who underwent symptom-driven coronary artery angiography after CABG were analyzed using Cox models and propensity scoring to compare outcomes based on the RBC transfusion status during their index CABG hospitalization.

RESULTS:

We analyzed 940 patients. We found that patients who received transfusions were more likely to have occluded grafts on angiography (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.03-1.50; p = 0.02). After adjusting for other factors, we found that RBC transfusion was associated with about a 20% increased hazard of graft occlusion (HR, 1.21; 95% CI,1.07-1.37; p = 0.003).

CONCLUSIONS:

Perioperative RBC transfusion is associated with graft occlusion after CABG at both the patient and graft levels. These results add to the growing body of evidence that homologous RBC transfusion is not risk free but is associated with a variety of adverse effects including midterm graft failure.