1. I MPACT OF P REOPERATIVE A NEMIA O N E ARLY AND L ATE O UTCOMES A FTER S URGICAL A ORTIC V ALVE R EPLACEMENT Rohan S. Menon BS, Wilson Szeto MD, Kanika Gupta BS, Prashanth Vallabhajosyula MD, Patrick Moeller BS, William Moser CRNP, Michael Acker MD, Joseph Bavaria MD, Nimesh Desai MD PhD Department of Cardiovascular Surgery University of Pennsylvania, Philadelphia

2. I NTRODUCTION  Red cell transfusion has been correlated with poor outcomes after open heart surgery.  While some operative indications for transfusion may be difficult to modify, low preoperative hemoglobin may be addressed before surgery.  The purpose of this investigation was to determine the impact of low preoperative hemoglobin on outcomes after surgical aortic valve replacement (AVR) M ETHODS  Between 2008-2012, we performed 1706 AVRs. 570 (32%) of these cases included a concomitant CABG procedure.  Data were analyzed using standard univariate, survival, logistic regression methodologies.  Acute endocarditis cases were excluded.

3. R ESULTS  Preop anemia was strongly associated with periop blood transfusion(OR2.8 95%CI 2.1-3.8).  Among 658 females, anemia (preop Hgb≤11g/dl) was present in 198(30.1%). Among 1048 males, anemia (preop Hgb≤12g/dl) was present in 347(33.1%).  Multivariate risk factors for preop anemia included increasing patient age, diabetes, LV ejection fraction(LV EF) <40%, chronic renal insufficiency(CRI) and previous sternotomy.  Other risk factors for periop blood transfusion included: Increasing patient age, concomitant CABG, female gender, and previous sternotomy. In a fully adjusted model, preop anemia was associated with early mortality(OR1.8, 95%CI 1.2-3.1).  Other early mortality risk factors included: Increasing patient age, concomitant CABG, female gender, LV EF<40%, CRI and previous sternotomy.  Preop anemia was also highly associated with late mortality, log rank p<0.001.  Multivariate predictors of late mortality included; Preoperative anemia (HR1.8 95%CI 1.3-2.5), increasing patient age, diabetes, LV EF <40%, and CRI.

5.  Preoperative anemia is highly associated with mortality and this effect continues well beyond the perioperative period.  Strategies aimed at modifying this risk factor warrant further investigation. C ONCLUSION