Preoperative Correction of Anemia of Chronic Diseases and Application of Bloodless Technology in Mitral and Aortic Valve Replacement
The article is dedicated to the optimization of the treatment of postoperative anemia in patients with mitral and aortic valve replacement through blood saving technology (BST).
The aim. To investigate the preoperative combined effect of iron (III) hydroxide and erythropoietin on the level of postoperative anemia after mitral and aortic valve replacement (MAVR) through BST in the conditions of artificial circulation.
Material and methods. Preoperative levels of Hb, Ht, iron, and enzymes were studied in 53 patients with com-bined mitral and aortic heart defects. All the patients are divided into groups A, B, C. Patients with normal levels of Hb, Ht, RBC, iron were divided into groups A and B. Patients of group A were operated with the use of donor blood components, and in group B - no donor blood components were used. In group C where the patients had low iron values, preoperative iron correction and erythropoietin stimulation were performed. Operations in group C were performed using BST.
Results. According to the study results, the patients of group A needed sufficient volume components of donor blood (621.0 ± 103.0 ml of red cell mass and 713.0 ± 89.0 ml of fresh-frozen plasma) in the operative period. MAVR with BST in group B was possible without transfusion of donor blood preparations, however, Hb decrease by 17.1% dictated the need for preoperative preparation of donor blood components.
Correction of low levels of preoperative serum iron in group C resulted in its 8.9-fold rise compared to the pre-operative level, as well as Hb increase by 5.8%. The use of BST during MAVR reduces postoperative anemia by 7.7% and helps to avoid transfusion of donor blood components.
Conclusions. Correction of low preoperative levels of iron and erythropoietin in patients with mitral and aortic heart defects reduces the level of postoperative anemia after operations with mitral and aortic valve replacement through BST.
- Khubutiya MS, Solonin SA, Bazhenov AI, Kobzeva EN, Smirnova YuV, Godkov MA. [Risks of transmission blood-borne viral infections via blood transfusion, organ and tissue transplantation]. Transplantologiya. The Russian Journal of Transplantation. 2015;(4):23-33. Russian.
- Cutrell JB, Barros N, McBroom M, Luby J, Minhajuddin A, Ring WS, et al. Risk factors for deep sternal wound infection after cardiac surgery: Influence of red blood cell transfusions and chronic infection. Am J Infect Control. 2016 Nov 1;44(11):1302-1309. https://doi.org/10.1016/j.ajic.2016.03.027.
- Flegel WA. Pathogenesis and mechanisms of antibody-mediated hemolysis. Transfusion. 2015 Jul;55 Suppl 2(0):S47-58. https://doi.org/10.1111/trf.13147.
- Fernandez LA, MacSween JM, You CK, Gorelick M. Immunologic changes after blood transfusion in patients undergoing vascular surgery. Am J Surg. 1992 Feb;163(2):263-9. https://doi.org/10.1016/0002-9610(92)90114-7.
- Dubrov S, Balyak V. [Blood-saving strategies in surgical patients. Patient blood management. Review of up-to-date guidelines]. Pain, Anaesthesia and Intensive Care. 2020;1(90):9-15. Ukrainian.
- Kozek-Langenecker SA, Ahmed AB, Afshari A, Albaladejo P, Aldecoa C, Barauskas G, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016. Eur J Anaesthesiol. 2017 Jun;34(6):332-395. https://doi.org/10.1097/EJA.0000000000000630.
- Naito Y, Tsujino T, Matsumoto M, Sakoda T, Ohyanagi M, Masuyama T. Adaptive response of the heart to long-term anemia induced by iron deficiency. Am J Physiol Heart Circ Physiol. 2009 Mar;296(3):H585-93. https://doi.org/10.1152/ajpheart.00463.2008.
- Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Ferric carboxymaltose in pa-tients with heart failure and iron deficiency. N Engl J Med. 2009 Dec 17;361(25):2436-48. https://doi.org/10.1056/NEJMoa0908355.
- Shander A, Ferraris VA. More or less? The Goldilocks Principle as it applies to red cell transfusions. Br J Anaesth. 2017 Jun 1;118(6):816-819. https://doi.org/10.1093/bja/aex135.
- Lazorishinets VV, Popov VV, Gumenyuk BN, Dyachenko V. [Bloodsaving technology in surgery of mitral heart de-fects]. Cardiology in Belarus. 2016;3(46):366-376. Rus-sian.
- Dolynna OV. [Pathogenesis and ways of correcting anemia syndrome in patients with chronic heart failure]. Simeina medytsyna. 2016;(1):58-62. Ukrainian.
- Uskach TM, Kochetov AG, Tereschenko SN. [The Statistical Analysis of Prevalence of Anemia in Patients With Chronic Heart Failure]. Kardiologiia. 2011;1:11-7. Russian.
- O`Meara E, Clayton T, McEntegart M, McMurray JJ, Lang CC, Roger SD, et al. Clinical correlates and consequences of anemia in a broad spectrum of patients with heart failure: results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program. Circulation. 2006 Feb 21;113(7):986-994. https://doi.org/10.1161/CIRCULATIONAHA.105.582577.