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Predictors of blood transfusion use in robotic beating‐heart totally endoscopic coronary artery bypass with anastomotic connectors
Author(s) -
Kitahara Hiroto,
McCrorey Mackenzie,
Patel Brooke,
Nisivaco Sarah,
Balkhy Husam H
Publication year - 2019
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14150
Subject(s) - medicine , confidence interval , odds ratio , blood transfusion , anastomosis , perioperative , surgery , artery , cardiology , logistic regression
Background We sought to identify the independent predictors of blood transfusion requirement in robotic beating‐heart patients with totally endoscopic coronary artery bypass (TECAB). Methods We retrospectively reviewed patients undergoing TECAB with distal anastomotic connectors from July 2013 to May 2017 at our institution. The cohorts were divided into patients who received a blood transfusion (BT group) and patients who did not (non‐blood transfusion [NBT] group). Results Two‐hundred seventy‐four consecutive patients underwent TECAB, and 47 patients (17%; BT group) received BT. The BT group had a lower preoperative hemoglobin level and a higher rate of preoperative risk profiles and higher society of thoracic surgeons (STS) predicted the risk of mortality. Kaplan Meier analysis showed decreased 1‐year survival in the BT group compared with the NBT group (90.9% vs 96.4%; logrank, 0.017). The Youden index identified a preoperative hemoglobin cutoff value of 12.2 g/dL (sensitivity 60.9%, specificity 79.3%) and operative time of 300 minutes (sensitivity 61.7%, specificity 59.0%) for BT requirement. 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 BT requirement. Conclusions We found that preoperative hemoglobin and operative time were independent predictors of BT requirement during robotic beating‐heart TECAB. These data would help to select patients to minimize perioperative BT as well as predict outcomes after this procedure.