Thoracic Surgery Clinical Trial
Official title:
Impact of Preoperative Martial Deficiency on the Level of Blood Transfusion in Programmed Cardiac Surgery (CARMATS)
Observational study.
Blood transfusion is expensive, and has medical and safety consequences for patients who
benefit from it. In cardiac surgery, the data concerning the level of perioperative
transfusion are very heterogeneous from one center to another. In a large US cohort study of
798 cardiac surgery centers and 102,470 patients undergoing coronary artery bypass surgery,
the rate of blood transfusion varies from 8 to 93% depending on the center. It would appear
that the largest and most experienced centers have a blood transfusion rate of around 60%.
In addition to its beneficial role in reducing mortality induced by deep or poorly tolerated
anemia, current data from the literature also raise morbidity and mortality related to blood
transfusion. Murphy et al. Have shown, in an English cohort of cardiac surgery, that
transfusion of CGR was correlated with the occurrence of postoperative infections and
ischemic events, as well as early and late excess mortality. These effects appear as early as
the first transfused red blood cell, which is confirmed by a prospective Brazilian study with
a hazard ratio of death occurrence of 1.2 for each RBC transfused after cardiac surgery.
Preoperative anemia is found in 25% of patients in programmed cardiac surgery and its
etiologies are varied. Iron deficiency appears to be at the forefront, especially in coronary
patients for whom studies report up to 48% iron deficiency anemia. It may also be vitamin B12
deficiency or folate, chronic pathologies such as renal insufficiency, or any other common
cause of anemia.
According to the latest European recommendations, iron deficiency should be defined as <100
ng / mL ferritin or <300 ng / mL ferritin combined with a transferrin saturation <20%.
In cardiac surgery, iron deficiency affects 37% of preoperative patients and is associated
with more frequent preoperative and postoperative anemia. It is an independent risk factor
for postoperative blood transfusion, even in the absence of preoperatively associated anemia
It is currently recommended to seek iron deficiency preoperatively during the discovery of
any microcytic anemia and to achieve iron substitution if found. And also to seek
supplemental iron deficiency in all patients with cardiac insufficiency.
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