Red blood cell transfusion after stage I palliation is associated with worse clinical outcomes

Felina K. Mille, Aditya Badheka, Priscilla Yu, Xuemei Zhang, David F. Friedman, John Kheir, Sarah van den Bosch, Antonio G. Cabrera, Javier J. Lasa, Hannah Katcoff, Paula Hu, Santiago Borasino, Krissie Hock, Jordan Huskey, Jamie Weller, Harsh Kothari, Joshua Blinder

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


BACKGROUND: Packed red blood cell transfusion may improve oxygen content in single-ventricle neonates, but its effect on clinical outcomes after Stage 1 palliation is unknown. METHODS AND RESULTS: Retrospective multicenter analysis of packed red blood cell transfusion exposures in neonates after Stage 1 palliation, excluding those with intraoperative mortality or need for extracorporeal membrane oxygenation. Transfusion practice variability was assessed, and multivariable regression used to identify transfusion risk factors. After propensity score adjustment for severity of illness, clinical outcomes were compared between transfused and nontransfused subjects. Of 396 subjects, 323 (82%) received 930 postoperative red blood cell transfusions. Packed red blood cell volume (median 9–42 mL/kg [P<0.0001]), donor exposures (1–2 [P<0.0001]), transfusion number (1–3 [P<0.0001]), and pretransfusion hemoglobin (12.1–13 g/dL, P=0.0049) varied between sites. Cyanosis (P=0.02), chest tube output (P=0.0003), and delayed sternal closure (P=0.0033) increased transfusion risk. Transfusion was associated with prolonged mechanical ventilation (6 [interquartile range 4, 12] versus 3 [1, 5] days, P=0.02) and intensive care unit stay (19 [12, 33] versus 9 [6, 19] days, P=0.016). When stratified by number of transfusions (0, 1, or >1), duration of mechanical ventilation (3 [1, 5] versus 4 [3, 6] versus 9 [5, 16] days [P<0.0001]) and intensive care unit stay (9 [6, 19] versus 13 [8, 25] versus 21 [13, 38] days [P<0.0001]) increased for those transfused more than once. Most subjects who died were transfused, though the association with mortality was not significant. CONCLUSIONS: Packed red blood cell transfusion after Stage 1 palliation is common, and transfusion practice is variable. Transfusion is a significant predictor of longer intensive care unit stay and mechanical ventilation. Further studies to define evidence-based transfusion thresholds are warranted.

Original languageEnglish (US)
Article numbere015304
JournalJournal of the American Heart Association
Issue number10
StatePublished - 2020


  • Congenital heart disease
  • Neonates
  • Norwood operation
  • Red blood cell transfusion
  • Single ventricle
  • Stage I palliation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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