Abstract 13135: Transfusion Requirements and Outcomes of Adult Patients With Congenital Heart Disease Undergoing Cardiovascular Surgery

Abstract

The number of adults with congenital heart disease (CHD) requiring cardiovascular (CV) surgery is increasing rapidly in the current era. We hypothesized that exposure to perioperative blood products is associated with poorer outcomes in adults. All adults (≥18 years old) undergoing CV surgery between 2015 and 2020 were reviewed retrospectively. Associations between transfusion (no products vs. any products) and outcomes were studied by univariate logistic regression and Wilcoxon rank sum tests. Multivariate cox/logistic regression was used to assess (a) postoperative ventilation time and length of stay, and (b) major complications, respectively. Of 323 patients, 147 (45%) received blood products during and/or after surgery. The median age was 27 (interquartile range [IQR]: 22-36) years, there were 181 (46%) males, and 16 (5%) patients had single ventricle anatomy. In the entire cohort, 110 (34%) were on preoperative anticoagulants: 39 (22%) received no products and 71 (48%) received products (OR: 3.28, 95% CI: [2.03,5.31], p<0.0001), and 47 (15%) had prior sternotomies: 16 (9%) received no products and 31 (21%) received products (OR: 2.76, 95% CI: [1.44, 5.28], p=0.0022). Patients who received blood products had more complications overall (OR: 4.25, 95% CI: [2.10, 8.61], p<0.0001) specifically, postoperative bleeding (OR: 7.54, 95% CI: [2.16, 26.28], p=0.0015) and cardiac arrest (OR: 8.75, 95% CI: [1.06, 71.94], p=0.04). Transfusion was associated with greater frequency of thrombosis (OR: 6.55, 95% CI: [1.86, 23.11], p=0.0035), longer ventilation time (HR: 3.05, 95% CI: [2.38, 3.91], p<0.0001), and longer length of stay (HR: 2.65, 95% CI: [2.05, 3.42], p<0.0001). In conclusion, adults who received perioperative blood products experienced more complications and worse in-hospital outcomes. Future research on optimizing blood product transfusion based on risk prediction models is needed to improve outcomes in adults with CHD undergoing CV surgery.