The Impact of Complex Preoperative Preparation of Patients with Aortic Heart Diseases on the Level of Postoperative Anemia

  • B. M. Gumeniuk National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-7954-4769
  • V. V. Popov National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-2851-5589
  • A. K. Logutov National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
  • E. V. Aksenov National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
Keywords: iron (III) oxide products, aortic heart defect, blood-saving technique, artificial circulation

Abstract

In patients undergoing surgical treatment of aortic heart defects under artificial circulation, pre-operative correction of serum iron levels, and application of blood-saving techniques during surgery reduce the level of postoperative anemia.

The aim. To investigate the combined influence of preoperative correction of serum iron levels and blood-saving techniques in the early postoperative anemia in the surgical treatment of aortic heart defects under artificial circulation.

Material and methods. This study involves 133 patients with acquired aortic heart diseases undergoing surgical treatment under artificial circulation and aims at identifying the combined effect of preoperative correction of serum iron (III) hydroxide levels and blood-saving techniques on the level of postoperative anemia. The levels of iron, transport enzymes, blood corpuscles, Hb and Ht were investigated. All the patients were divided into 3 groups. Group A (control group) included 52 patients in whom iron levels were within the normal range and donated blood components were used during the intervention. Group B (study group) included 43 patients in whom iron levels were within the normal range and blood-saving techniques were used during the intervention. Group C (adjustment group) included 38 patients with low iron levels and anemia, which was interpreted as anemia of chronic disease (ACD). Preoperative correction of serum iron levels and intraoperative blood-saving techniques were applied in this group.

Results. For the purpose of perioperative anemia correction, transfusion of 539.8 ± 9.1 ml (p¤0.05) of packed red blood cells and 582.4 ± 77.2 ml (p¤0.05) of fresh frozen plasma was given in Group A patients. In the Group B, the use of blood-saving techniques during the intervention allowed us to obtain good clinical effect without perioperative transfusion of blood products. It was established that in Group C preoperative correction of serum iron enabled to achieve 5.6 times higher level of serum iron (p¤0.05), 2 times higher transferrin saturation, and 7.3 times higher ferritin activity (p¤0.05), as well as increase preoperative Hb level by 9.5 % and decrease postoperative anemia by 8.7 %.

Conclusions. Correction of low baseline serum iron in patients with chronic anemia (ACD) provides 5.6 times increase in preoperative serum iron (SI) (p¤0.05), increases hemoglobin by 9.5% (p¤0.05), and reduces the level of postoperative anemia in patients undergoing surgical treatment of aortic heart defects under artificial circulation with the use of blood-saving techniques and without the use of donor blood and Cell Saver.

References

  1. Lewis CE, Hiratzka LF, Woods SE, Hendy MP, Engel AM. Autologous blood transfusion in elective cardiac valve operations. J Card Surg. 2005 Nov-Dec; 20(6):513–8. https://doi.org/10.1111/j.1540-8191.2005.00137.x
  2. [Hematology and blood transfusion: interdepartamental collection]. 38th ed. Kyiv; 2015. Ukrainian.
  3. Khubutiya MSh, Solonin SA, Bazhenov AI, Kobzeva EN, Smirnova YuV, Godkov MA. [Risks of transmitting blood-borne viral infections via blood transfusion, organ and tissue transplantation]. Transplantologia. 2015;4: 23–33. Russian.
  4. Gumenyuk BM. [Detection of Markers of Infections that are Transmitted Throughdonors Blood to Cardiac Surgery Patients Hospital]. The yearbook of scientific works of Ukrainian Society of Cardiovascular Surgery. 2011;19:122–5. Ukrainian.
  5. 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
  6. Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009 Dec 17;361(25):2436–48. https://doi.org/10.1056/NEJMoa0908355.
  7. Curley GF, Shehata N, Mazer CD, Hare GM, Friedrich JO. Transfusion triggers for guiding RBC transfusion for cardiovascular surgery: a systematic review and meta-analysis. Crit Care Med. 2014;42(12):2611–24. https://doi.org/10.1097/CCM.0000000000000548
  8. 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;34(6):332–95. https://doi.org/10.1097/EJA.0000000000000630
  9. Lazorishinetz V, Popov V, Gumenyuk B, Dyachenko V. [Bloodsaving technology in surgery of mitral heart defects]. Cardiology in Belarus. 2016;8(3):21–5. Russian.
  10. Dolynna OV. [Pathogenesis and ways of correcting anemia syndrome in patients with chronic heart failure]. Simeina medytsyna. 2016;(1):58–62. Ukrainian.
  11. 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.]. Kardiolog
  12. 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;113(7):986–94. https://doi.org/10.1161/CIRCULATIONAHA.105.582577
Published
2020-05-26
How to Cite
Gumeniuk, B. M., Popov, V. V., Logutov, A. K., & Aksenov, E. V. (2020). The Impact of Complex Preoperative Preparation of Patients with Aortic Heart Diseases on the Level of Postoperative Anemia. Ukrainian Journal of Cardiovascular Surgery, (2 (39), 37-42. https://doi.org/10.30702/ujcvs/20.3905/026037-042