Authors
Turaeva R.R., Shestakov E.A., Gudymovich V.G., Katkov A.A., Zhiburt E.B.
Pirogov National Medical and Surgical Center, Moscow
Abstract
When analyzing 171 medical records of patients of the Pirogov Center who underwent open heart surgery (coronary artery bypass grafting, valve replacement) in 2023-2024, it was found that during treatment (the average hospitalization period in a surgical hospital is 10.9±0.6 days), the average hemoglobin concentration decreases to 91.8±2.2 g/l in women and 100.9±2.5 g/l in men.
The need for blood transfusion developed in 73.8% of women and 31.8% of men. 28.7% of patients received hardware reinfusion of autologous red blood cells, which in 53% of cases allowed to avoid allogeneic transfusion. 96.5% of patients received tranexamic acid and 22.2% - iron preparations. It is advisable to include the use of blood components, blood salvage and other patient blood management technologies in clinical guidelines and the standard of medical care for adult cardiac surgery patients.
Keywords: cardiac surgery, cardiopulmonary bypass, blood transfusion, patient blood management, standard, evidence-based medicine.
References
1. Shevchenko YL, Karpov OE, Zhiburt EB. Blood transfusion: history and modernity (on the 100th anniversary of blood transfusion in Russia). Vestnik Nacional'nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2019; 14(4): 4-11. (In Russ.) doi: 10.25881/BPNMSC.2020.29.78.001.
2. Zhiburt EB. Patient blood management for critical bleeding and massive transfusion. Vestnik Nacional'nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2013; 8(4): 71-77. (In Russ.)
3. Shevchenko YL, Zhiburt EB, Shestakov EA. The implementation of a blood-saving ideology in the practice of the Pirogov Center. Vestnik Nacional'nogo mediko-hirurgicheskogo centra im. N.I.Pirogova. 2008; 3(1): 14-21. (In Russ.)
4. Shevchenko YuL, Matveev SA, Chechetkin AV. Cardiosurgical transfusiology. Moscow: Classic-Consulting; 2000 (In Russ.)
5. Mamadaliev DM, Farkhutdinov FF, Shestakov EA, et al. Preoperative risk factors for anemia and red blood cell transfusion during cardiac surgery. Vestnik Nacional'nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2015; 10(2): 27-31. (In Russ.)
6. Zhiburt EB, Madzaev SR, Gubanova MN, Burkitbaev ZhK. Results of the study of indications for blood transfusion in elderly surgical patients. Vestnik Nacional'nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2012; 7(3): 75-76. (In Russ.)
7. Shevchenko YL, Popov LV, Gorokhovatsky YuI, et al. Formation of thoracic and cardiovascular surgery in the Pirogov Center: 21st century – traditions and achievements (on the 20th anniversary of the St. George Clinic of Thoracic and Cardiovascular Surgery). Vestnik Nacional'nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2021; 16(2): 4-15. (In Russ.) doi: 10.25881/20728255_2021_16_2_4.
8. Shestakov EA, Karavaev AV, Vasilashko VI, Zhiburt EB. Standardization of blood transfusion in cardiovascular surgery Vestnik Nacional'nogo mediko-hirurgicheskogo centra im. N.I.Pirogova. 2012; 7(1): 107-111. (In Russ).
9. Gubanova MN, Serba IK, Shestakov EA, et al. Evolution of blood transfusion in the Pirogov Center Vestnik Nacional'nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2017; 12(4, Р1): 90-92. (In Russ.)
10. Shevchenko YL, Stoyko YuM, Zamyatin MN. Blood-sparing effect of tranexamic acid: clinical significance. Farmateka. 2008; 16(170): 17-23. (In Russ.)
11. Pohabov DS, Bayuklin AV, YAgosfarov AN, et al. Reinfuziya krovi: sostoyanie i perspektivy. Transfuziologiya. 2023; 24(3): 202-218. (In Russ.)
12. Pokhabov DS, Bayuklin AV, Yagosfarov AN, et al. Blood salvage: status and prospects. Transfusiology. 2023; 18(2): 15-20. (In Russ.)
13. Karpov OE, Nikitenko DN, Lyashchev SA. New management technologies. System of management standards. Vestnik Nacional'nogo mediko-hirurgicheskogo centra im. N.I.Pirogova. 2013; 8(2): 87-90. (In Russ.)
14. WHO, Chan M. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switzerland: World Health Organization. 2011.
15. Clinical guidelines «Anemia in malignant neoplasms», 2024 (ID:624). (In Russ.)
16. Arya S, Howell A, Vernich L, et al. Re-evaluating treatment thresholds in patient blood management: Female patients experience more perioperative anaemia and higher transfusion rates in major elective surgery. Vox Sang. 2024; 119(10): 1090-1095. doi: 10.1111/vox.13717.
17. Clinical guidelines "Infective endocarditis and infection of intracardiac devices", 2024 (ID:624). (In Russ.)
18. Kuznetsov SI, Averyanov EG, Shestakov EA, Zhiburt EB. Damage of red blood cells during storage and its prevention. Transfusiology. 2020; 21(4): 325-336. (In Russ.)
19. Clinical guidelines «Atrial ventricular septal defect (Atrioventricular canal)», 2024 (ID:709). (In Russ.)
20. Clinical guidelines «Coarctation of the aorta», 2024 (ID:754). (In Russ.)
21. Clinical guidelines «Stable ischemic heart disease», 2020 (ID:155). (In Russ.)
22. Order of the Ministry of Health of Russia dated 02.03.2021 №159n «On approval of the standard of medical care for adults with hypertrophic cardiomyopathy (diagnosis, treatment and dispensary observation)». (In Russ.)
23. Order of the Ministry of Health of Russia dated 10.06.2021 №612n (as amended on 27.05.2022) «On approval of the standard of medical care for adults with acute myocardial infarction with ST segment elevation of the electrocardiogram (diagnosis, treatment and dispensary observation)». (In Russ.)
24. Order of the Ministry of Health of Russia dated 28.04.2021 №410n «On approval of the standard of medical care for adults with stable coronary heart disease (diagnosis, treatment and dispensary observation)». (In Russ.)
