Preoperative anaemia is a risk factor for mortality and morbidity following aortic valve surgery.

OBJECTIVES The impact of anaemia on patients undergoing aortic valve surgery has not been well studied. We sought to evaluate the effect of anaemia on early outcomes following aortic valve replacement (AVR). METHODS All patients undergoing non-emergent aortic valve surgery (n = 2698) with or without other concomitant procedures between 1997 and 2010 were included. Preoperative anaemia was defined as per World Health Organization guidelines as haemoglobin (Hb) < 130 g/l in men and Hb < 120 g/l in women. Multivariable analyses were used to determine the association between preoperative anaemia and postoperative outcomes. RESULTS The prevalence of preoperative anaemia was 32.2%. Patients with anaemia were older (71 ± 12 vs 66 ± 13 years, P < 0.001), more likely to have urgent surgery, recent MI, higher creatinine level and impaired preoperative left ventricular function. Overall unadjusted mortality was 2.8% in non-anaemic patients vs 8% in anaemic patients. Anaemic patients were more likely to require renal replacement therapy (11 vs 3%, P < 0.0001) and prolonged ventilation (24 vs 10%, P < 0.0001). Following multivariable adjustment, lower preoperative Hb was an independent predictor of mortality (odds ratio 1.19, 95% CI: 1.04-1.34, P = 0.007) and composite morbidity (odds ratio 1.36, 95% CI: 1.05-1.77, P = 0.02) after AVR. Mortality and composite morbidity were significantly higher with lower levels of preoperative Hb. CONCLUSIONS Preoperative anaemia is a common finding in patients undergoing aortic valve surgery and is an important and potentially modifiable risk factor for postoperative morbidity and mortality.

[1]  S. Leal-Noval,et al.  Preoperative anemia in elective cardiac surgery: prevalence, risk factors, and influence on postoperative outcome: PREOPERATIVE ANEMIA IN CARDIAC SURGERY , 2010 .

[2]  A. Della Corte,et al.  Preoperative anemia in patients undergoing coronary artery bypass grafting predicts acute kidney injury. , 2009, The Journal of thoracic and cardiovascular surgery.

[3]  G. Grunwald,et al.  Does preoperative hemoglobin independently predict short-term outcomes after coronary artery bypass graft surgery? , 2008, Annals of Thoracic Surgery.

[4]  M. W. Massyn,et al.  Heyde syndrome: a common diagnosis in older patients with severe aortic stenosis. , 2008, Age and ageing.

[5]  B. Reeves,et al.  Increased mortality, morbidity, and cost associated with red blood cell transfusion after cardiac surgery , 2008, Current opinion in cardiology.

[6]  H. Nishikawa,et al.  Hemolytic anemia with aortic stenosis resolved by urgent aortic valve replacement. , 2008, The Annals of thoracic surgery.

[7]  D. Wijeysundera,et al.  Risk Associated With Preoperative Anemia in Cardiac Surgery: A Multicenter Cohort Study , 2008, Circulation.

[8]  T. Gardner.  To transfuse or not to transfuse. , 2007, Circulation.

[9]  I. C. Tudor,et al.  Impact of Preoperative Anemia on Outcome in Patients Undergoing Coronary Artery Bypass Graft Surgery , 2007, Circulation.

[10]  P. Friedmann,et al.  Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. , 2007, JAMA.

[11]  A. Go,et al.  Hemoglobin Level, Chronic Kidney Disease, and the Risks of Death and Hospitalization in Adults With Chronic Heart Failure: The Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study , 2006, Circulation.

[12]  T. Mihaljevic,et al.  Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. , 2006, The Annals of thoracic surgery.

[13]  J. Vila,et al.  Is pre-operative anaemia a risk marker for in-hospital mortality and morbidity after valve replacement? , 2006, European heart journal.

[14]  J. Guralnik,et al.  Anemia in old age is associated with increased mortality and hospitalization. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[15]  Luigi Ferrucci,et al.  Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. , 2004, Blood.

[16]  S. Wade,et al.  Prevalence and outcomes of anemia in cancer: a systematic review of the literature. , 2004, The American journal of medicine.

[17]  R. Habib,et al.  Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? , 2003, The Journal of thoracic and cardiovascular surgery.

[18]  D. Fergusson,et al.  Review of the clinical practice literature on patient characteristics associated with perioperative allogeneic red blood cell transfusion. , 2003, Transfusion medicine reviews.

[19]  K. Taylor,et al.  Preoperative hemoglobin concentration and mortality rate after coronary artery bypass surgery , 2002 .

[20]  K. Taylor,et al.  Preoperative haemoglobin concentration and mortality rate after coronary artery bypass surgery , 2002, The Lancet.

[21]  J. Dunne,et al.  Perioperative anemia: an independent risk factor for infection, mortality, and resource utilization in surgery. , 2002, The Journal of surgical research.

[22]  J. Carroll,et al.  Etiology of preoperative anemia in patients undergoing scheduled cardiac surgery , 1999, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[23]  B. Lytle,et al.  Transfusion increases the risk of postoperative infection after cardiovascular surgery. , 2006, Journal of the American College of Surgeons.

[24]  J. Carson,et al.  Evaluation and management of anemia and bleeding disorders in surgical patients. , 2003, The Medical clinics of North America.