Bloody Transplants! Impact of Prior Sternotomy on Transfusion Rate in Heart Transplantation

Abstract

<h3>Purpose</h3> Ventricular Assist device (VAD) patients are at higher risk of bleeding at the time of heart transplant. Moreover, the quantity of packed red cells (RBC) received during the first 24 hours postoperatively correlates with increased mortality. Whether this is related to surgical issues or due to the anticoagulation associated with VADs is unknown. <h3>Methods</h3> Operative transfusion requirements and demographics data was obtained from our hospital cardiothoracic database for all patients who underwent heart transplantation between 2006 and 2020. Patients were divided into three groups - No previous sternotomy (NPS), VAD explant (VE) and Previous (non-VAD) Sternotomy (PS). Biventricular VAD, total artificial heart explants and multi-organ transplants were excluded. <h3>Results</h3> 428 patients were included in the analysis. Median age was 54 years (IQR 43-61), 131 patients were female (31%), median eGFR was 78ml/min/1.73m2 (IQR 54-95). 236 patients (54.2%) were in the NPS group, 133 (31.1%) in the VE group and 62 patients (14.6%) in the PS group. There was a strong association between blood transfusion and re-do sternotomy (both VE and PS groups) (p<0.001), but no difference between the VE and PS groups. A lower mean eGFR (<78ml/min/1.73m2) was associated with higher transfusion requirement (P<0.001). <h3>Conclusion</h3> Sternotomy patients (with or without VAD explant) demonstrated a higher RBC transfusion requirement compared to clean skin and these patients tended to have a lower renal function post-operatively. The lack of difference in RBC requirement between VE and PS patients suggest that anticoagulated VAD patients who have received Vitamin K do not necessarily have higher bleeding risk than other re-do sternotomy patients.