Blood Product Utilization with Left Ventricular Assist Device Implantation: A Decade of Statewide Data

Abstract

Blood transfusion rates with cardiac surgery over time have decreased, this trend has not been examined for patients undergoing left ventricular assist device (LVAD) implantation. We investigated blood transfusion trends with LVAD implantation in a statewide database. Between July 2004 and June 2014, 666 LVADs were implanted (age 54.5 ± 12.6 years. 77% men). Reoperation for bleeding was required in 22% of cases. Postoperative mortality was 13.2%. Over the decade, use of any blood products with LVAD surgery by year ranged from 83% to 100% (92 ± 5.3%). Intraoperative and postoperative blood products use was 71.8% and 73%, respectively. Only 7.4% of patients did not receive any blood products. Blood transfusion during surgery consisted of plasma (60%), platelets (56%), red blood cells (RBCs) (44.3%), and cryoprecipitate (32%), whereas after surgery RBC use was more frequent (68%). Compared with the initial 5 years (2005–2009), the units of blood transfused in the second 5 years (2010–2014) were significantly less, 21 ± 23 units vs. 16.6 ± 20.5 units, p = 0.0038. By multivariable analysis, preoperative factors predictive of blood transfusion are lower hematocrit, lower BMI, reoperative surgery, requirement for intraaortic balloon pump (IABP), and nonelective surgery. Blood transfusion with LVAD implantation remains very high. However, the amount of blood product transfused has decreased in the last 5 years.