Is small volume, up to 2 red blood cell units transfusion required and redeemable in cardiac surgery? / Szükséges-e, kiváltható-e a kis volumenu vörösvértest-koncentrátum transzfúziója a szívmutétekben? Befolyásoló tényezok

Introduction: Low-volume (1-2 U) transfusion affects more than a quarter of cardiac surgical patients. This may increase the incidence of complications, mortality, and blood use, even in low-risk patients. Objective: By analyzing risk factors, we searched for measures to reduce the frequency of low-volume transfusions. Method: The risk factors for transfusion of up to 2 U red blood cells were examined in 1011 patients. We compared data from 276 (27.3%) patients who received low-volume transfusion (study group) with 448 (44.3%) patients who received no transfusion (control group). 287 patients (28,4%), who received more than 2 U red blood cells, were excluded. Multivariate logistic regression analysis of data was performed. Results: The factors affecting low-volume transfusion were female gender (OR= 2.048; p = 0.002), age (OR= 1.033; p = 0.002), body weight (OR= 0.954; p<0.001), preoperative hemoglobin value of <130 g/l (OR = 3.185; p<0.001), preoperative glomerular filtration rate <60 ml/min/1.73 m(2) (OR = 1.750; p = 0.026), off-pump coronary artery bypass surgery (OR = 0.371; p<0.001), combined procedures (OR = 2.432; p = 0.015), perioperative fluid balance (OR = 1.227; p = 0.005), intraoperative bleeding and preoperative clopidogrel treatment (OR = 1.002; p<0.001), postoperative bleeding >1200 ml/24 hours (OR= 2.438; p<0.005). Conclusion: Screening and treatment of preoperative anemia, decreasing operative hemodilution, increasing the number of minimally invasive and off-pump procedures as well as applying a surgical hemostasis protocol could be a solution to avoid low-volume transfusion in cardiac surgery.

Successful combined application of reoperation protocol with target-guided hemostatic therapy for the treatment of severe bleeding in cardiac surgical patients / Reoperációs algoritmus és célvezérelt haemostasisterápia együttes, sikeres alkalmazása súlyos szívsebészeti vérzés kezelésében.

INTRODUCTION: Bleeding and transfusions following cardiac surgery significantly increase the rate of complications. Early diagnosis of "surgical" and "coagulopathic" bleeding is a prerequisite for effective treatment. Thromboelastometry with targeted hemostasis therapy can help in setting up the indication for reoperation and reduction of blood loss, transfusions and costs. AIM: We aimed to develop a local "reoperation for bleeding" protocol derived from the data of our former patients. METHOD: Based on data from 1011 cardiac surgical patients (control group), we developed a statistical algorithm to distinguish between "coagulopathic" and "surgical" bleeding. We used viscoelastic coagulation test and risk stratification. In 112 consecutive patients (study group), we examined the reoperations, and the impact of the protocol on the rates of transfusions and treatment costs. RESULTS: There was no difference in the rate of reoperations between the two groups (6.2% vs. 5.4%; p = 0.584). No coagulopathic bleeding occurred in the study group, compared to 12.7% in the control group. In the study group, we experienced reduction in bleeding (p = 0.026), an increased application of fibrinogen (p<0.001), prothrombin complex concentrate (p<0.001), and tranexamic acid (p<0.001). Red blood cell transfusions decreased by 30% (1.7 ± 2.6 E vs. 2.3 ± 3.3 E; p = 0.012). No difference was found in the amounts of fresh frozen plasma or platelet transfusions used. Calculated cost savings were HUF -20,333 per patient. CONCLUSION: Using this algorithm, reoperations were performed only in cases of surgical bleeding. The amount of bleeding, requirement for transfusions and treatment costs were reduced. Orv Hetil. 2020; 161(34): 1414-1422.

[Evaluation of the EuroSCORE model in the patient population of our department of cardiac surgery]. / A EuroSCORE-modell értékelése szívsebészeti osztályunk megoperált betegei között.

INTRODUCTION: The objective of current study is the evaluation of the accuracy and precision of EuroSCORE in the population of those patients undergone cardiac surgery in our department. MATERIAL AND METHODS: We have analyzed the data of 1839 consecutive patients who had their operations between 1/January 2003 and 31/December 2005. We have compared the mortality rates predicted preoperatively by additive and logistic EuroSCORE with the actual 30-day mortality figures. On statistical analysis the discriminative accuracy of the methods has been defined with the use of C-statistics. The calibration and precision of the methods have been checked by the Hosmer-Lemeshow statistics. RESULTS: The overall mortality rate in the above period was 3.3%. Additive and logistic EuroSCORE predicted 4.1 +/- 2.8 and 4.5 +/- 6.1%, consecutively. Based on the C-statistics the area below the Receiver Operating Characteristic curve has measured 0.699 (0.629-0.769) and 0.711 (0.642-0.779). The kappa 2 value for the Hosmer-Lemeshow statistics has proved 6.5 ( p = 0.475) and 12.5 ( p = 0.131). CONCLUSION: Logistic EuroSCORE has appropriate discriminative power and satisfactory precision, whilst the accuracy of additive EuroSCORE only comes near to the acceptable level, but at the same time it has an adequate calibration value. These results suggest that logistic EuroSCORE is more suitable for the preoperative risk assessment of these patients.

[Postoperative renal failure and its risk factors after open heart surgery]. / Nyitott szívmútéteket követó veseelégtelenség és rizikótényezói.

AIM: In this retrospective study the authors have investigated the occurrence and the possible risk factors of renal failure following heart surgery on CPB. PATIENTS AND METHODS: 52 perioperative variables of 536 consecutive patients undergoing cardiac surgery have been analysed. Types of surgery were as follows: coronary-bypass: 266 (49.6%), combined coronary-bypass: 62 (11.5%), valve replacement: 171 (31.9%), adult repair of congenital: disease 24 (4.4%), aortic dissection: 6 (1.1%), others 7 (1.3%). In the past medical history those patients involved in the study chronically impaired renal function could be found in 2.2%, whilst kidney stone and chronic pyelonephritis appeared in 2.4% and 1.2% respectively. Postoperative renal failure developed in 31 patients (5.8%), 3 of them required haemodialysis (0.6%). For the statistical analysis chi 2 test, t-test, Levine-test, Mann-Whitney-test and logistic regression analysis were applied using the SPSS software. RESULTS: On the basis of the performed multivariable logistic regression analysis the risk factors of renal failure following open heart surgery are as follows: age, duration of anaesthesia, chronic pyelonephritis in past medical history, preoperative serum creatinine level and low cardiac output syndrome.