Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec;7(6):3573-3581.
doi: 10.1002/ehf2.12780. Epub 2020 Oct 14.

The effect of transfusion of blood products on ventricular assist device support outcomes

Supriya Shore  1 , Thomas C Hanff  2 , Jeremy A Mazurek  2 , Matthew Seigerman  2 , Robert Zhang  2 , Edward W Grandin  3 , Esther Vorovich  4 , Paul Mather  2 , Caroline Olt  2 , Jessica Howard  5 , Joyce Wald  2 , Michael A Acker  5 , Lee R Goldberg  2 , Pavan Atluri  5 , Kenneth B Margulies  2 , J Eduardo Rame  2 , Edo Y Birati  2
Affiliations

The effect of transfusion of blood products on ventricular assist device support outcomes

Supriya Shore et al. ESC Heart Fail. 2020 Dec.

Abstract

Aims: Perioperative blood transfusions are common among patients undergoing left ventricular assist device (LVAD) implantation. The association between blood product transfusion at the time of LVAD implantation and mortality has not been described.

Methods and results: This was a retrospective cohort study of all patients who underwent continuous flow LVAD implantation at a single, large, tertiary care, academic centre, from 2008 to 2014. We assessed used of packed red blood cells (pRBCs), platelets, and fresh frozen plasma (FFP). Outcomes of interest included all-cause mortality and acute right ventricular (RV) failure. Standard regression techniques were used to examine the association between blood product exposure and outcomes of interest. A total of 170 patients were included in this study (mean age: 56.5 ± 15.5 years, 79.4% men). Over a median follow-up period of 11.2 months, for every unit of pRBC transfused, the hazard for mortality increased by 4% [hazard ratio (HR) 1.04; 95% CI 1.02-1.07] and odds for acute RV failure increased by 10% (odds ratio 1.10; 95% CI 1.05-1.16). This association persisted for other blood products including platelets (HR for mortality per unit 1.20; 95% CI 1.08-1.32) and FFP (HR for mortality per unit 1.08; 95% CI 1.04-1.12). The most significant predictor of perioperative blood product exposure was a lower pre-implant haemoglobin.

Conclusions: Perioperative blood transfusions among patients undergoing LVAD implantation were associated with a higher risk for all-cause mortality and acute RV failure. Of all blood products, FFP use was associated with worst outcomes. Future studies are needed to evaluate whether pre-implant interventions, such as intravenous iron supplementation, will improve the outcomes of LVAD candidates by decreasing need for transfusions.

Keywords: Left ventricular assist device; Right ventricular failure; Transfusions.

PubMed Disclaimer

Conflict of interest statement

Birati consulted for American Regent, Inc., and received research support from Impulse Dynamics and Medtronic. Goldberg is a consultant for Medtronic and Respircardia. Margulies is in the advisory committees of Novo Nordisk and Astra‐Zeneca and received research grant support from Juventis Therapeutics, Celladon, Thoratec, and Innolign Biomedical. Rame received research grant support from Medtronic and Abbott.

Figures

Figure 1
Figure 1
Association between survival and perioperative packed red blood cell (pRBC) transfusion Kaplan–Meier curves showing survival of the study cohort stratified into two groups on the basis of number of perioperative pRBC units transfused.
Figure 2
Figure 2
Change in panel reactive antibodies before and 3 months after left ventricular assist device (LVAD) implant: (A) for the entire cohort and (b) stratified by gender.
See this image and copyright information in PMC

References

    1. Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Myers SL, Miller MA, Baldwin JT, Young JB. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant 2015; 34: 1495–1504. - PubMed
    1. Genovese EA, Dew MA, Teuteberg JJ, Simon MA, Kay J, Siegenthaler MP, Bhama JK, Bermudez CA, Lockard KL, Winowich S, Kormos RL. Incidence and patterns of adverse event onset during the first 60 days after ventricular assist device implantation. Ann Thorac Surg 2009; 88: 1162–1170. - PMC - PubMed
    1. Miller LW, Pagani FD, Russell SD, John R, Boyle AJ, Aaronson KD, Conte JV, Naka Y, Mancini D, Delgado RM, MacGillivray TE, Farrar DJ, Frazier OH, HeartMate IICI. Use of a continuous‐flow device in patients awaiting heart transplantation. N Engl J Med 2007; 357: 885–896. - PubMed
    1. Aaronson KD, Slaughter MS, Miller LW, McGee EC, Cotts WG, Acker MA, Jessup ML, Gregoric ID, Loyalka P, Frazier OH, Jeevanandam V, Anderson AS, Kormos RL, Teuteberg JJ, Levy WC, Naftel DC, Bittman RM, Pagani FD, Hathaway DR, Boyce SW. HeartWare ventricular assist device bridge to transplant ATI. Use of an intrapericardial, continuous‐flow, centrifugal pump in patients awaiting heart transplantation. Circulation 2012; 125: 3191–3200. - PubMed
    1. Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ. Effect of blood transfusion on long‐term survival after cardiac operation. Ann Thorac Surg 2002; 74: 1180–1186. - PubMed

Publication types