DOES SMOKING AFFECT PERIOPERATIVE BLOOD LOSS IN PATIENTS UNDERGOING CARDIAC VALVULAR SURGERY (AORTIC OR MITRAL)?

Abstract

Introduction: The effect of nicotine and other noxious chemicals are carcinogenic in cigarette smoke and can cause damage to the intima of blood vessels and therefore interfere with thrombus formation and the healing process. Hence we hypothesize that chronic active smokers may have greater blood loss following valvular surgery. [1,2] Methods: With approval from institutional ethics committee we retrospective studied and analyzed the data from 498 patients who underwent valvular surgery. There were 83 active smokers and 415 non smokers. Both groups were comparable in terms of mean age, sex, CPB time, X- clamp time, dose of heparin, protamine, tranexamic acid and lowest hematocrit on CPB. The preoperative coagulation tests were normal in both groups. The intraoperative and postoperative blood loss was measured at 6 and 24 hour in the ICU. The mean (SD) were analyzed using chi squared and paired t-test. Results: The 6 hour blood loss was significantly greater (364ml) in the smokers, compared to non-smokers (208ml) (p<.05) and the 24 hour blood loss was also greater in smokers but not statistically significant (Figure 1). Postoperative coagulation tests were normal in both groups.Figure 1: 6hr and 24hr Blood Loss Post-Valve Surgery: Smokers vs. Non-SmokersDiscussion: There was a significantly greater blood loss in active smokers undergoing valvular surgery in comparison to the matched control of non-smokers. There is a need to study patients who stop smoking in the preoperative period and the effect on blood loss.