Association of Hemoglobin and Transfusion With Outcome After Operations for Hypoplastic Left Heart

• Published in: The Annals of thoracic surgery Vol. 89; no. 5; pp. 1378 - 1384.e2
• Main Authors: Blackwood, Jaime, MD, Joffe, Ari R., MD, Robertson, Charlene M.T., MD, Dinu, Irina A., PhD, Alton, Gwen, BScN, Penner, Karen, PhD, Ross, David B., MD, Rebeyka, Ivan M., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2010; Elsevier
• Subjects: Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Cardiology. Vascular system; Cardiothoracic Surgery; Cause of Death; Cohort Studies; Confidence Intervals; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Erythrocyte Transfusion - adverse effects; Erythrocyte Transfusion - methods; Female; Follow-Up Studies; Heart; Hemoglobins - analysis; Hospital Mortality - trends; Humans; Hypoplastic Left Heart Syndrome - diagnosis; Hypoplastic Left Heart Syndrome - mortality; Hypoplastic Left Heart Syndrome - surgery; Infant; Infant, Newborn; Male; Medical sciences; Multivariate Analysis; Odds Ratio; Pneumology; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Surgery; Survival Rate; Treatment Outcome; 21; Prognosis; Transfusion; Cardiovascular disease; Left Heart Hypoplasia; Operation; Congenital disease; Association; Treatment; Heart disease; Surgery; Hemoglobin; Anesthesia; Circulatory system; Cardiology
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2010.01.064

Background Red blood cell transfusions may or may not improve oxygen delivery to the tissues. Some studies suggest transfusion might contribute to adverse outcomes. This study investigated the association between hemoglobin concentration and transfusion with outcome in cyanotic neonates undergoing Norwood operations. Methods Infants 6 weeks old or younger with hypoplastic left heart syndrome undergoing staged Norwood operations between September 1996 and July 2005 were included. Demographics and preoperative, operative, and postoperative variables were collected prospectively. Hemoglobin concentration, transfusion, fluid balance, and chest tube losses were collected retrospectively. The association of variables with outcomes, including early and 2-year mortality, mental and psychomotor developmental indices at 18 to 24 months of age, and ventilator days were determined by univariate and multiple regression analyses. Results Ninety-four patients had Norwood operations. Excluded were 10 requiring postoperative extracorporeal life support and 2 with chromosomal abnormalities. By multiple regression analysis, only a higher nadir hemoglobin on days 2 to 5 postoperatively was associated with higher early mortality (odds ratio, 2.09; 95% confidence interval [CI], 1.14 to 3.87; p = 0.018), and the highest preoperative dopamine dose and highest epinephrine dose on day 2 to 5 postoperatively were associated with 2-year mortality; however, neither hemoglobin concentration nor number of transfusions were associated with mental or psychomotor developmental indices. The number of transfusions on day 2 to 5 postoperatively was associated with ventilator days in multiple variable analysis (effect size, 1.85; 95% CI, 0.33 to 3.36; p = 0.018). Conclusions This single-center cohort study found transfusion was not associated with improved outcomes in neonates undergoing Norwood operations.