Cardiac surgery

Approximately 646,000 open heart procedures performed annually in the U.S.

Approximately 1-1.25 million patients worldwide undergo such procedures.

60 day mortality twice as high in patients transfused with unmodified RBC’s versus leukocyte depleted RBC’s (7.9% v.3.6%).

Readmission to hospital after cardiac surgery is common, occurring in 8-24% of discharged patients within 30 days of discharge.

Unplanned readmission within 30 days associated with diabetes, female sex, chronic lung problems, preoperative atrial fibrillation and preoperative chronic renal insufficiency.

High risk procedures such as repeat coronary artery bypass, valve replacements and combined procedures associated with increased risk of death, bleeding, renal failure, and thrombotic complications, compared to first time CABG procedures.

With coronary artery bypass grafting and valvular surgery have a perioperative myocardial infarction rate of 7-15%.

Postoperative atrial fibrillation ranges between 27-40% of cases.

Intravenous hydrocortisone reduces the relative risk of postoperative AF by 37% compared with placebo in patients undergoing CABG surgery, aortic valve replacement or combined CABG and aortic valve replacement.

Intraoperative hyperglycemia is an independent risk factor for complications, including death and improved glucose control should be attempted to reduce risks in diabetic patients.

Associated with a high rate of the blood transfusions, ranging from 40-90%.

Acute kidney injury complicates cardiac surgery in up to 30% of patients.

Even mild postoperative acute kidney injury associated with a 5-fold increase in death while in the hospital.

Acute kidney injury following cardiac surgery associated with higher rates of postoperative arrhythmias, respiratory failure, systemic infection, and myocardial infarction.

In a comparative trial of 428 patients undergoing CABG, reducing the hemoglobin trigger for blood transfusions to 8 g/dL does not adversely affect patient outcomes (Bracey AW et al).

Excessive bleeding requiring blood component transfusion is common after cardiac surgery and is associated with increased morbidity and mortality.

Cardiac surgery related bleeding is often multi factorial and includes acquired hypofibrinogenemia, which is treated with either cryoprecipitate or fibrinogen concentrate.

In patients undergoing cardiac fever surgery who developed clinically significant bleeding with hypo fibrinogenemia after cardiac pulmonary bypass, fibrinogen concentrate is non-inferior to cryoprecipitate with regard to the number of blood components transfused in a 24 hours post bypass.

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