Risk Factors And Prognosis For Blood Transfusion In Pediatric Patients Undergoing Open Heart Surgery With Cardiopulmonary Bypass

Objective:To identify the risk factors of intraoperative blood transfusion and explore the relationship between intraoperative blood transfusion and postoperative prognosis in our pediatric cardiac surgery population.Methods:We carried out a retrospective review of medical records for 1028 consecutive CHD children undergoing open heart surgery with CPB, which consist of patients’ demographic, operation data, intraoperative blood product transfusion and prognosis. We analyzed the predictors of transfusion of the different blood products with multivariate linear regression. On the basis of postoperative prognosis, we divided the patients into four groups:mortality group, survival group, morbidity group and no-morbidity group. The independent risk factors of postoperative mortality and morbidity were determined with multivariate logistic regression analysis. Cox proportional hazards model was performed to determine the relationship of intraoperative blood product transfusion to the duration of postoperative mechanical ventilation and ICU stay.Results:Of the 1028 patients included,802(78%) receive blood transfusion,769(74.7%) receive RBC,80(7.8%) receive plasma,61(5.9%) receive platelet,104(10.1%) receive cryoprecipitate. During the postoperative period,45 patients (4.4%) died,143(13.9%) had low cardiac output syndrome,43(4.2%) required dialysis,26(2.5%) sustained pulmonary failure,17(1.7%) had infection, and 28(2.7%) developed neurologic complications. Multivariate linear regression showed an independent relationship between age, reoperation, lowest temperature of CPB, duration of CPB, preoperative cyanosis, RACHS category, DHCA, as well as delayed sternal closure and intraoperative blood transfusion. Multivariate logistic regression analysis indicated that duration of CPB, lowest temperature of CPB, postoperative Pediatric Risk of Mortality III Score and the amount of RBC transfusion(>median) were the significant predictors of postoperative hospital mortality; preoperative cyanosis, duration of CPB, postoperative Pediatric Risk of Mortality Score, the mediastinal drain loss in the first 6 postoperative hours and the amount of RBC transfusion(>median) were the independent risk factors of postoperative morbidity. Cox hazard regression analysis showed that the patients receiving RBC transfusion of more than 25ml·kg-1 had longer duration of postoperative mechanical ventilation (hazard ratio=0.71,95% CI 0.57-0.89, P=0.004) and ICU stay (hazard ratio=0.69,95%CI 0.56-0.87, P=0.001) compared with those receiving no RBC transfusion.Conclusion:If young pediatric patients who had a history of thoracotomy operation and preoperative cyanosis, or underwent complex operation needed longer duration of low temperature CPB, DHCA and delayed sternal closure, the probability of intraoperative blood transfusion was likely to be higher. Massive RBC transfusion not only prolonged duration of postoperative mechanical ventilation and ICU stay, but also was associated with an increased incidence of postoperative hospital mortality and morbidity. So minimizing intraoperative RBC transfusion would be beneficial for postoperative prognosis in pediatric patients undergoing open heart surgery with CPB.