RBC transfusion common, predicts mortality in patients undergoing valve surgery for IE

Most patients with infective endocarditis (IE) have anaemia and go on to receive red blood cell (RBC) transfusion during valve surgery, as reported in a retrospective multicentre cohort study. However, those who receive a transfusion are at increased risk of death.

Researchers used data from the Netherlands Heart Registration and looked at 2,480 patients (median age 65 years, 77.3 percent male) who underwent valve surgery for active IE. Aortic valve surgery was the most common procedure (67.6 percent), followed by mitral (43.5 percent), tricuspid (6.5 percent), and pulmonary (1 percent) valve surgery. Double and triple valve surgeries were performed in 18.3 percent and 2 percent of patients, respectively.

Outcomes of interest were anaemia (defined according to the WHO criteria), RBC transfusion, and 30-day and 1-year mortality.

A total of 84.9 percent had preoperative anaemia, which was moderate in 50.7 percent and severe in 2.8 percent. There were 78.7 percent of patients who received RBC transfusion during surgery. The 30-day and 1-year mortality rates were 10.6 percent and 16.6 percent, respectively.

In multivariable analysis, RBC transfusion emerged as an independent predictor of mortality at both 30 days (adjusted hazard ratio [aHR], 3.58, 95 percent confidence interval [CI], 2.07–6.19; p<0.001) and 1 year (aHR, 2.71, 95 percent CI, 1.79–4.12; p<0.001).

These findings underscore the need for improved anaemia management and individualized transfusion strategies in patients with IE undergoing cardiac surgery.