Impact of infusion of red blood cell suspension at different perioperative periods in patients with valvular heart disease: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Shan ¹ , FU Bo ² , WEI Ao ³ , ZHANG Qian ⁴ , CAO Yaqing ¹ , JIANG Nan ² ,  GUO Zhigang ²

1. Department of Blood Transfusion, Tianjin Chest Hospital, Tianjin, 300222, P. R. China;
2. Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, 300222, P. R. China;
3. Department of Cardiology, Tianjin Chest Hospital, Tianjin, 300222, P. R. China;
4. Department of Clinical Lab, Tianjin Chest Hospital, Tianjin, 300222, P. R. China;

Corresponding?author：

GUO Zhigang, Email: Zhigangguo@yahoo.com

Keywords：

Perioperative period; red cell suspension; valvular heart disease; transfusion

DOI：

10.7507/1007-4848.202404034

Video：

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Objective To investigate the impact of red blood cell suspension infusion across various perioperative periods on patients with valvular heart disease. Methods The patients with valvular heart disease admitted to Tianjin Chest Hospital from 2018 to 2020 were selected. Based on the timing of perioperative red cell suspension infusion, patients were categorized into three groups: a group 1 receiving intraoperative red cell suspension infusion, a group 2 receiving red cell suspension infusion within 24 hours after entering the ICU, and a group 3 receiving red cell suspension infusion at both time points. The laboratory results, perioperative blood component infusion volume, and other relevant parameters were retrospectively analyzed. After propensity score matching, the differences in different variables among the three groups were compared. Results After propensity score matching, 102 patients were enrolled, including 52 males and 50 females, with an average age of (61.74±10.58) years. There were 34 patients in each group. The preoperative hemoglobin (Hb) value of the group 2 was significantly higher than that of the group 1 and the group 3, and the amount of red cell suspension and autoblood transfusion was the lowest (P<0.05). Group 1 had the highest postoperative Hb, as well as the highest Hb and hematocrit (HCT) levels within 24 hours post-surgery (P<0.05). The group 1 had the lowest plasma, platelet and cryoprecipitate infusion volumes, and the shortest cardiopulmonary bypass time, aortic occlusion time, postoperative ICU stay and hospital stay, and the least blood loss and total drainage volume (P<0.05). The difference between postoperative and preoperative Hb (△Hb1) was highest in group 1 (P<0.05). Conclusion For patients with valvular heart disease, intraoperative-only infusion of red blood cell suspension is associated with a better prognosis at discharge and during follow-up.

Citation： XU Shan, FU Bo, WEI Ao, ZHANG Qian, CAO Yaqing, JIANG Nan, GUO Zhigang. Impact of infusion of red blood cell suspension at different perioperative periods in patients with valvular heart disease: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(5): 772-777. doi: 10.7507/1007-4848.202404034 Copy

1.	Prakash M, Sharma V, Oh T, et al. Evaluation of the effects of three designs of oxygenators with integrated filters on clinical and haematological outcomes at an Australasian cardiothoracic unit. Perfusion, 2023, 38(5): 983-992.
2.	Yu Y, Fu Y, Li W, et al. Red blood cell transfusion in neurocritical patients: a systematic review and meta-analysis. BMC Anesthesiol, 2024, 24(1): 106.
3.	Chavez Ortiz JL, Griffin I, Kazakova SV, et al. Transfusion-related errors and associated adverse reactions and blood product wastage as reported to the National Healthcare Safety Network Hemovigilance Module, 2014-2022. Transfusion, 2024, 64(4): 627-637.
4.	Paone G, Likosky DS, Brewer R, et al. Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality. Ann Thorac Surg, 2014, 97(1): 87-93.
5.	Horvath KA, Acker MA, Chang H, et al. Blood transfusion and infection after cardiac surgery. Ann Thorac Surg, 2013, 95(6): 2194-2201.
6.	Patel NN, Avlonitis VS, Jones HE, et al. Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis. Lancet Haematol, 2015, 2(12): e543-e553.
7.	Yasmin F, Jawed S, Najeeb H, et al. Comparative efficacy and safety of mitral valve repair versus mitral valve replacement in rheumatic heart disease: a high-value care systematic review and meta-analysis. Curr Probl Cardiol, 2024, 49(6): 102530.
8.	Bayliss CD, Maier R, Kasim A, et al. Does blood transfusion have an effect on outcomes after aortic valve replacement surgery? Heart Lung Circ, 2021, 30(6): 909-916.
9.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
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11.	Zhou H, Lan J, Zhu H, et al. Evaluation for perioperative blood transfusion during major abdominal procedures in a pediatric population: a retrospective observation cohort study. Transfus Med Hemother, 2020, 47(1): 68-74.
12.	Dai CQ, Wang LH, Zhu YQ, et al. Risk factors of perioperative blood transfusion in elderly patients with femoral intertrochanteric fracture. Medicine(Baltimore), 2020, 99(15): e19726.
13.	Zeroual N, Blin C, Saour M, et al. Restrictive transfusion strategy after cardiac surgery. Anesthesiology, 2021, 134(3): 370-380.
14.	Houston BL, Fergusson DA, Falk J, et al. Evaluation of transfusion practices in noncardiac surgeries at high risk for red blood cell transfusion: a retrospective cohort study. Transfus Med Rev, 2021, 35(1): 16-21.
15.	Rahman EU, Chobufo MD, Farah F, et al. Prevalence and temporal trends of anemia in patients with heart failure. QJM, 2022, 115(7): 437-441.
16.	Colombo C, Rebora P, Montalto C, et al. Hospital-acquired anemia in patients with acute coronary syndrome: epidemiology and potential impact on long-term outcome. Am J Med, 2023, 136(12): 1203-1210.
17.	de Melo DG, da Cruz Rodrigues VC, de Sá Pereira GJ, et al. Effects of aerobic exercise on the regulation of mitochondrial carrier homolog-2 and its influence on the catabolic and anabolic activity of lipids in the mesenteric adipose tissue of obese mice. Life Sci, 2024, 345: 122567.
18.	Spinelli E, Bartlett RH. Anemia and transfusion in critical care: physiology and management. J Intensive Care Med, 2016, 31(5): 295-306.
19.	Napolitano LM. Anemia and red blood cell transfusion: advances in critical care. Crit Care Clin, 2017, 33(2): 345-364.
20.	Hsing V, Zhao HQ, Post M, et al. Preservation of recipient plasma sphingosine-1-phosphate levels reduces transfusion-related acute lung injury. Am J Physiol Lung Cell Mol Physiol, 2024, 326(5): L589-L595.
21.	Uzair M, Singhal C, Ali A, et al. Myocardial ischemia-reperfusion injury released cellular fibronectin containing domain A (CFN-EDA): a destructive positive loop amplifying arterial thrombosis formation and exacerbating myocardial reperfusion injury. Thromb Res, 2024, 238: 117-128.
22.	Wang P, Zheng L, Yan S, et al. Understanding the role of red blood cells in venous thromboembolism: a comprehensive review. Am J Med Sci, 2024, 367(5): 296-303.
23.	Zou Y, Jiang Y, Zhu D, et al. Fibrinogen as a potential diagnostic marker for prediction and evaluation of postpartum hemorrhage: a retrospective study. J Matern Fetal Neonatal Med, 2024, 37(1): 2300418.
24.	Grigg W, Mahfooz F, Chaudhary D, et al. HbA1c and FIB-4 as serologic markers for the risk of progression of stage A heart failure. Glob Cardiol Sci Pract, 2021, 2021(4): e202125.
25.	Hu X, Li R, Wu Y, et al. Thermosensitive heparin-poloxamer hydrogel encapsulated bFGF and NGF to treat spinal cord injury. J Cell Mol Med, 2020, 24(14): 8166-8178.
26.	Ding CY, Lian BQ, Ge HL, et al. Predictive factors of postoperative infection-related complications in adult patients with cerebral cavernous malformations. Sci Rep, 2020, 10(1): 863.
27.	Tian WZ, Er JX, Liu L, et al. Effects of autologous platelet rich plasma on intraoperative transfusion and short-term outcomes in total arch replacement (Sun's procedure): a prospective, randomized trial. J Cardiothorac Vasc Anesth, 2019, 33(8): 2163-2169.
28.	Wu T, Liu J, Wang Q, et al. Superior blood-saving effect and postoperative recovery of comprehensive blood-saving strategy in infants undergoing open heart surgery under cardiopulmonary bypass. Medicine (Baltimore), 2018, 97(27): e11248.
29.	Farbu BH, Lydersen S, Mohus RM, et al. The detrimental effects of intestinal injury mediated by inflammation are limited in cardiac arrest patients: a prospective cohort study. Resusc Plus, 2024, 18: 100639.
30.	?im?ek M, Y?ld?r?m F, Tay?i MR, et al. Role of IL-6 in the adjustment of the medical treatment of patients with COVID-19 associated acute respiratory distress syndrome. J Ayub Med Coll Abbottabad, 2022, 34(3): 410-416.
31.	Zheng ZL, Ma JW, Luo Y, et al. Mechanism of dexmedetomidine protection against cisplatin induced acute kidney injury in rats. Ren Fail, 2024, 46(1): 2337287.
32.	Martucci C, Allen AD, Moretto N, et al. CHF6297: a novel potent and selective p38 MAPK inhibitor with robust anti-inflammatory activity and suitable for inhaled pulmonary administration as dry powder. Front Pharmacol, 2024, 15: 1343941.
33.	Li X, Liang Q, Liu L, et al. FTO attenuates TNF-α-induced damage of proximal tubular epithelial cells in acute pancreatitis-induced acute kidney injury via targeting AQP3 in an N6-methyladenosine-dependent manner. Ren Fail, 2024, 46(1): 2322037.
34.	Omeiza NA, Bakre A, Ben-Azu B, et al. Mechanisms underpinning Carpolobia lutea G. Don ethanol extract's neurorestorative and antipsychotic-like activities in an NMDA receptor antagonist model of schizophrenia. J Ethnopharmacol, 2023, 301: 115767.

1. Prakash M, Sharma V, Oh T, et al. Evaluation of the effects of three designs of oxygenators with integrated filters on clinical and haematological outcomes at an Australasian cardiothoracic unit. Perfusion, 2023, 38(5): 983-992.
2. Yu Y, Fu Y, Li W, et al. Red blood cell transfusion in neurocritical patients: a systematic review and meta-analysis. BMC Anesthesiol, 2024, 24(1): 106.
3. Chavez Ortiz JL, Griffin I, Kazakova SV, et al. Transfusion-related errors and associated adverse reactions and blood product wastage as reported to the National Healthcare Safety Network Hemovigilance Module, 2014-2022. Transfusion, 2024, 64(4): 627-637.
4. Paone G, Likosky DS, Brewer R, et al. Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality. Ann Thorac Surg, 2014, 97(1): 87-93.
5. Horvath KA, Acker MA, Chang H, et al. Blood transfusion and infection after cardiac surgery. Ann Thorac Surg, 2013, 95(6): 2194-2201.
6. Patel NN, Avlonitis VS, Jones HE, et al. Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis. Lancet Haematol, 2015, 2(12): e543-e553.
7. Yasmin F, Jawed S, Najeeb H, et al. Comparative efficacy and safety of mitral valve repair versus mitral valve replacement in rheumatic heart disease: a high-value care systematic review and meta-analysis. Curr Probl Cardiol, 2024, 49(6): 102530.
8. Bayliss CD, Maier R, Kasim A, et al. Does blood transfusion have an effect on outcomes after aortic valve replacement surgery? Heart Lung Circ, 2021, 30(6): 909-916.
9. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
10. Napier JA, Bruce M, Chapman J, et al. Guidelines for autologous transfusion. Ⅱ. Perioperative haemodilution and cell salvage. British Committee for Standards in Haematology Blood Transfusion Task Force. Autologous Transfusion Working Party. Br J Anaesth, 1997, 78(6): 768-771.
11. Zhou H, Lan J, Zhu H, et al. Evaluation for perioperative blood transfusion during major abdominal procedures in a pediatric population: a retrospective observation cohort study. Transfus Med Hemother, 2020, 47(1): 68-74.
12. Dai CQ, Wang LH, Zhu YQ, et al. Risk factors of perioperative blood transfusion in elderly patients with femoral intertrochanteric fracture. Medicine(Baltimore), 2020, 99(15): e19726.
13. Zeroual N, Blin C, Saour M, et al. Restrictive transfusion strategy after cardiac surgery. Anesthesiology, 2021, 134(3): 370-380.
14. Houston BL, Fergusson DA, Falk J, et al. Evaluation of transfusion practices in noncardiac surgeries at high risk for red blood cell transfusion: a retrospective cohort study. Transfus Med Rev, 2021, 35(1): 16-21.
15. Rahman EU, Chobufo MD, Farah F, et al. Prevalence and temporal trends of anemia in patients with heart failure. QJM, 2022, 115(7): 437-441.
16. Colombo C, Rebora P, Montalto C, et al. Hospital-acquired anemia in patients with acute coronary syndrome: epidemiology and potential impact on long-term outcome. Am J Med, 2023, 136(12): 1203-1210.
17. de Melo DG, da Cruz Rodrigues VC, de Sá Pereira GJ, et al. Effects of aerobic exercise on the regulation of mitochondrial carrier homolog-2 and its influence on the catabolic and anabolic activity of lipids in the mesenteric adipose tissue of obese mice. Life Sci, 2024, 345: 122567.
18. Spinelli E, Bartlett RH. Anemia and transfusion in critical care: physiology and management. J Intensive Care Med, 2016, 31(5): 295-306.
19. Napolitano LM. Anemia and red blood cell transfusion: advances in critical care. Crit Care Clin, 2017, 33(2): 345-364.
20. Hsing V, Zhao HQ, Post M, et al. Preservation of recipient plasma sphingosine-1-phosphate levels reduces transfusion-related acute lung injury. Am J Physiol Lung Cell Mol Physiol, 2024, 326(5): L589-L595.
21. Uzair M, Singhal C, Ali A, et al. Myocardial ischemia-reperfusion injury released cellular fibronectin containing domain A (CFN-EDA): a destructive positive loop amplifying arterial thrombosis formation and exacerbating myocardial reperfusion injury. Thromb Res, 2024, 238: 117-128.
22. Wang P, Zheng L, Yan S, et al. Understanding the role of red blood cells in venous thromboembolism: a comprehensive review. Am J Med Sci, 2024, 367(5): 296-303.
23. Zou Y, Jiang Y, Zhu D, et al. Fibrinogen as a potential diagnostic marker for prediction and evaluation of postpartum hemorrhage: a retrospective study. J Matern Fetal Neonatal Med, 2024, 37(1): 2300418.
24. Grigg W, Mahfooz F, Chaudhary D, et al. HbA1c and FIB-4 as serologic markers for the risk of progression of stage A heart failure. Glob Cardiol Sci Pract, 2021, 2021(4): e202125.
25. Hu X, Li R, Wu Y, et al. Thermosensitive heparin-poloxamer hydrogel encapsulated bFGF and NGF to treat spinal cord injury. J Cell Mol Med, 2020, 24(14): 8166-8178.
26. Ding CY, Lian BQ, Ge HL, et al. Predictive factors of postoperative infection-related complications in adult patients with cerebral cavernous malformations. Sci Rep, 2020, 10(1): 863.
27. Tian WZ, Er JX, Liu L, et al. Effects of autologous platelet rich plasma on intraoperative transfusion and short-term outcomes in total arch replacement (Sun's procedure): a prospective, randomized trial. J Cardiothorac Vasc Anesth, 2019, 33(8): 2163-2169.
28. Wu T, Liu J, Wang Q, et al. Superior blood-saving effect and postoperative recovery of comprehensive blood-saving strategy in infants undergoing open heart surgery under cardiopulmonary bypass. Medicine (Baltimore), 2018, 97(27): e11248.
29. Farbu BH, Lydersen S, Mohus RM, et al. The detrimental effects of intestinal injury mediated by inflammation are limited in cardiac arrest patients: a prospective cohort study. Resusc Plus, 2024, 18: 100639.
30. ?im?ek M, Y?ld?r?m F, Tay?i MR, et al. Role of IL-6 in the adjustment of the medical treatment of patients with COVID-19 associated acute respiratory distress syndrome. J Ayub Med Coll Abbottabad, 2022, 34(3): 410-416.
31. Zheng ZL, Ma JW, Luo Y, et al. Mechanism of dexmedetomidine protection against cisplatin induced acute kidney injury in rats. Ren Fail, 2024, 46(1): 2337287.
32. Martucci C, Allen AD, Moretto N, et al. CHF6297: a novel potent and selective p38 MAPK inhibitor with robust anti-inflammatory activity and suitable for inhaled pulmonary administration as dry powder. Front Pharmacol, 2024, 15: 1343941.
33. Li X, Liang Q, Liu L, et al. FTO attenuates TNF-α-induced damage of proximal tubular epithelial cells in acute pancreatitis-induced acute kidney injury via targeting AQP3 in an N6-methyladenosine-dependent manner. Ren Fail, 2024, 46(1): 2322037.
34. Omeiza NA, Bakre A, Ben-Azu B, et al. Mechanisms underpinning Carpolobia lutea G. Don ethanol extract's neurorestorative and antipsychotic-like activities in an NMDA receptor antagonist model of schizophrenia. J Ethnopharmacol, 2023, 301: 115767.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Impact of infusion of red blood cell suspension at different perioperative periods in patients with valvular heart disease: A propensity score matching study

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