Author + information
- Faisal Mattoa,b,
- Peter Kouretasa,b,
- Richard Smitha,b,
- Jacob Ostrowskya,b,
- Anthony Cinaa,b,
- Douglas Hessa,b,
- Jonathan Stamlera,b and
- James D. Reynoldsa,b
Background: Allogenic transfusion during pediatric cardio-pulmonary bypass can replace a significant portion of a child's blood volume with banked red blood cells (RBCs). Within hours of procurement, RBCs exhibit impairments in nitric oxide (NO)-based vasodilation and oxygen delivery capability reflected in declines in S-nitrosohemoglobin (SNO-Hb). Thus, administration of even freshly stored blood may impair tissue oxygenation and worsen outcome.
Methods: In this prospective observational study we tracked the relationship between circulating SNO-Hb levels and post-transfusion outcomes in 20 children <12 months of age undergoing surgical repair of congenital cardiac defects. Per hospital protocol, all subjects received washed RBCs that had been stored for < 5 days.
Results: Intra-operative transfusion volume directly correlated with post-operative ventilator time and ICU stay and was associated with a decline in kidney tissue oxygenation and SNO-Hb levels even as arterial oxygen content increased. Accordingly, post-operative SNO-Hb levels inversely correlated with transfusion volume (increase in Hb) and renal function, i.e. the lower the SNO-Hb levels the worse the estimated glomerular filtration rate. Finally, regression analysis identified circulating SNO-Hb levels as an inverse predictor of outcome.
Conclusions: In young children undergoing cardiac surgery, large volume transfusion negatively impacts circulating SNO-Hb levels and is associated with worse outcome. Follow-on studies are required to validate SNO-Hb as an independent prognostic biomarker of transfusion response and to determine if maintenance of RBC-derived NO bioactivity can confer therapeutic benefit.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Congenital Heart Disease: Progress in Pediatric Heart Surgery
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1101-015
- 2017 American College of Cardiology Foundation