Kinnunen Eeva-Maija, De Feo Marisa, Reichart Daniel, Tauriainen Tuomas, Gatti Giuseppe, Onorati Francesco, Maschietto Luca, Bancone Ciro, Fiorentino Francesca, Chocron Sidney, Bounader Karl, Dalén Magnus, Svenarud Peter, Faggian Giuseppe, Franzese Ilaria, Santarpino Giuseppe, Fischlein Theodor, Maselli Daniele, Dominici Carmelo, Nardella Saverio, Gherli Riccardo, Musumeci Francesco, Rubino Antonino S, Mignosa Carmelo, Mariscalco Giovanni, Serraino Filiberto G, Santini Francesco, Salsano Antonio, Nicolini Francesco, Gherli Tiziano, Zanobini Marco, Saccocci Matteo, Ruggieri Vito G, Philippe Verhoye Jean, Perrotti Andrea, Biancari Fausto
Department of Surgery, Oulu University Hospital, Oulu, Finland.
Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
Transfusion. 2017 Jan;57(1):178-186. doi: 10.1111/trf.13885. Epub 2016 Oct 23.
Excessive bleeding and blood transfusion are associated with adverse outcome after cardiac surgery, but their mechanistic effects are difficult to disentangle in patients with increased operative risk. This study aimed to evaluate the incidence and prognostic impact of bleeding and transfusion of blood products in low-risk patients undergoing coronary artery bypass grafting (CABG).
Sixteen tertiary European centers of cardiac surgery contributed to the prospective European registry of CABG (E-CABG). The severity of bleeding was defined by the E-CABG bleeding severity classification and universal definition of perioperative bleeding (UDPB) classification.
Of 1213 patients with EuroSCORE II of less than 2% (mean, 1.1 ± 0.4%), 18.5% suffered from mild bleeding (E-CABG bleeding Grade 1) and 3.4% experienced severe bleeding (E-CABG bleeding Grade 2-3). Similarly, 19.7% had UDPB Class 2 and 5.9% had UDPB Classes 3 and 4. Mild and severe bleeding defined by the E-CABG and UDPB classifications were associated with an increased risk of several adverse events as adjusted by multiple covariates. The risk of death, stroke, and acute kidney injury was particularly increased in patients with severe bleeding.
Severe bleeding is rather uncommon in low-risk patients undergoing CABG, but it is associated with an increased risk of major adverse events. Prevention of excessive perioperative bleeding and patient blood management may improve the outcome of cardiac surgery also in low-risk patients.
心脏手术后出血过多和输血与不良预后相关，但在手术风险增加的患者中，其机制性影响难以区分。本研究旨在评估接受冠状动脉旁路移植术（CABG）的低风险患者出血和输血制品的发生率及预后影响。
欧洲16个三级心脏外科中心参与了前瞻性欧洲冠状动脉旁路移植术注册研究（E-CABG）。出血严重程度由E-CABG出血严重程度分类和围手术期出血通用定义（UDPB）分类来定义。
在欧洲心脏手术风险评估系统（EuroSCORE）II评分低于2%（平均为1.1±0.4%）的1213例患者中，18.5%发生轻度出血（E-CABG出血1级），3.4%经历严重出血（E-CABG出血2 - 3级）。同样，19.7%的患者为UDPB 2级，5.9%的患者为UDPB 3级和4级。经多个协变量调整后，E-CABG和UDPB分类定义的轻度和重度出血与几种不良事件风险增加相关。严重出血患者的死亡、中风和急性肾损伤风险尤其增加。
在接受CABG的低风险患者中，严重出血相当少见，但与主要不良事件风险增加相关。预防围手术期出血过多和进行患者血液管理也可能改善低风险患者心脏手术的结局。
