Independent Predictors Of Blood Transfusion Use In Robotic Beating Heart Connector Totally Endoscopic Coronary Artery Bypass
Hiroto Kitahara, Brook Patel, Mackenzie McCrorey, Sarah Nisivaco, Husam H. Balkhy.
The University of Chicago, Chicago, IL, USA.
BACKGROUND Sternal sparing and off-pump coronary artery bypass surgery have been shown to decrease perioperative blood transfusion requirements. However some patients undergoing robotic totally endoscopic coronary artery bypass (TECAB) require one or more blood transfusions. We sought to study the independent predictors of blood transfusion requirement in our beating heart connector TECAB patients. METHODS We retrospectively reviewed patients undergoing connector TECAB (C-TECAB) from July 2013 to May 2017 at our institution. The cohorts were divided into patients requiring blood transfusion (BT group) and not (NBT group). RESULTS 274 Consecutive patients underwent C-TECAB, and 47 patients (17 %) received blood transfusion. Preoperative hemoglobin was lower in the BT group compared to the NBT group (11.7 ± 2.2 g/dl vs 13.5 ± 1.8 g/dl, P < 0.001). The BT group had longer operative time (320.4 ± 99.9 minutes vs 277.6 ± 86.1 minutes, P = 0.007). Mean change in hemoglobin immediately after C-TECAB was 1.5 ± 1.0 g/dl in the NBT group, which was similar to 1.7 ± 1.3 g/dl in the BT group (excluding patients requiring intraoperative blood transfusion). The Youden index identified a preoperative hemoglobin cutoff value of 12.2 g/dl (area under curve 0.740, sensitivity 60.9 %, specificity 79.3 %) and operative time of 300 minutes (area under curve 0.625, sensitivity 61.7 %, specificity 59.0 %) for blood transfusion use. Multivariate logistic regression analysis identified a preoperative hemoglobin < 12.2 g/dl (odds ratio 6.03, 95 % confidence interval 3.01-12.1) and an operative time > 300 minutes (odds ratio 2.15, 95% confidence interval 1.07-4.33) as independent factors associated with blood transfusion use. 30-day mortality (1.4% overall) was higher in the BT group (8.5 % vs 0.0 %, P = 0.001). Kaplan Meier analysis showed decreased 1-year survival in the BT group compared to the NBT group (90.9 % vs 96.4 %, Log rank 0.017). CONCLUSIONS We found that preoperative hemoglobin and operative time were independent predictors of blood transfusion requirement (17%) during robotic beating heart C-TECAB at our institution. These data maybe helpful in selecting patients to minimize perioperative blood transfusion as well as in predicting outcomes after this procedure.
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