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. 2021 May 20;3(5):e0417.
doi: 10.1097/CCE.0000000000000417. eCollection 2021 May.

RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure

Fabio Savorgnan  1 , Priya N Bhat  1 , Paul A Checchia  1 , Sebastian Acosta  2 , Sebastian C Tume  1 , Javier J Lasa  1 , Vicken Asadourian  3 , Barbara-Jo Achuff  1 , Saul Flores  1 , Mubasheer Ahmed  1 , Daniel I Crouthamel  4 , Rohit S Loomba  5 , Ronald A Bronicki  1
Affiliations

RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure

Fabio Savorgnan et al. Crit Care Explor. .

Abstract

The transfusion of stored RBCs decreases nitric oxide bioavailability, which may have an adverse effect on vascular function. We assessed the effects of RBC transfusion on coronary vascular function by evaluating the relationship between myocardial oxygen delivery and demand as evidenced by ST segment variability.

Design: Retrospective case-control study.

Setting: Nine-hundred seventy-three-bed pediatric hospital with a 54-bed cardiovascular ICU.

Patients: Seventy-three neonates with hypoplastic left heart syndrome following the Norwood procedure, 38 with a Blalock-Taussig shunt and 35 with a right ventricle to pulmonary artery shunt.

Interventions: RBC transfusion.

Materials and main results: High-frequency physiologic data were captured 30 minutes prior to the initiation of (baseline) and during the 120 minutes of the transfusion. A rate pressure product was calculated for each subject and used as an indicator of myocardial oxygen demand. Electrocardiogram leads (aVL, V1, II) were used to construct a 3D ST segment vector to assess ST segment variability and functioned as a surrogate indicator of myocardial ischemia. One-hundred thirty-eight transfusions occurred in the Blalock-Taussig shunt group and 139 in the right ventricle to pulmonary artery shunt group. There was no significant change in the rate pressure product for either group; however, ST segment variability progressively increased for the entire cohort during the transfusion, becoming statistically significant by the end of the transfusion. Upon subgroup analysis, this finding was noted with statistical significance in the Blalock-Taussig shunt group and trending toward significance in the right ventricle to pulmonary artery shunt group.

Conclusions: We found a significant increase in the ST segment variability and evidence of myocardial ischemia temporally associated with RBC transfusions in neonates following the Norwood procedure, specifically among those in the Blalock-Taussig shunt group, which may impact immediate and long-term outcomes.

Keywords: Norwood procedure; electrocardiogram; hypoplastic left heart syndrome; neonate; nitric oxide; red blood cell transfusion.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Three-dimensional view of the electrocardiogram leads needed for the ST segment vector calculations. The frontal plane is spanned by the (y, z) axes. The transverse plane is spanned by the (x, y) axes. The sagittal plane is spanned by the (x, z) axes.
Figure 2.
Figure 2.
ST segment vector variability (mean ± se) over time. The linear trend with positive slope indicates increasing variability over time (p = 0.047).
See this image and copyright information in PMC

References

    1. Yin Z, Yu B, Liu W, et al. : Blood transfusion and mortality in myocardial infarction: An updated meta-analysis. Oncotarget 2017; 8:102254–102262 - PMC - PubMed
    1. Chatterjee S, Wetterslev J, Sharma A, et al. : Association of blood transfusion with increased mortality in myocardial infarction: A meta-analysis and diversity-adjusted study sequential analysis. JAMA Intern Med 2013; 173:132–139 - PubMed
    1. Mille FK, Badheka A, Yu P, et al. : Red blood cell transfusion after stage I palliation is associated with worse clinical outcomes. J Am Heart Assoc 2020; 9:e015304. - PMC - PubMed
    1. Blackwood J, Joffe AR, Robertson CM, et al. ; Western Canadian Complex Pediatric Therapies Follow-up Group: Association of hemoglobin and transfusion with outcome after operations for hypoplastic left heart. Ann Thorac Surg 2010; 89:1378–84.e1 - PubMed
    1. Donadee C, Raat NJ, Kanias T, et al. : Nitric oxide scavenging by red blood cell microparticles and cell-free hemoglobin as a mechanism for the red cell storage lesion. Circulation 2011; 124:465–476 - PMC - PubMed