Skip to main content

Red blood cell transfusion results in worse outcomes in patients with left ventricular dysfunction undergoing on-pump cardiac surgery


Cardiac surgeries are associated with high rates of bleeding and consequently with high rates of allogeneic transfusion. Patients with left ventricular dysfunction usually present a higher incidence of complications after cardiac surgery, including low output syndrome and organ dysfunction. It is a matter of controversy whether this subgroup of patients need higher hemoglobin levels to optimize oxygen delivery. We aimed to evaluate the association of transfusion with worse outcomes in patients with left ventricular dysfunction.


A prospective cohort study was conducted in 215 patients undergoing cardiac surgery, presenting ejection fraction <35%. We recorded baseline characteristics, intraoperative data, transfusion requirement and severe postoperative complications as need for reoperation, acute kidney injury, arrhythmia, severe sepsis, septic shock, bleeding, stroke, and death during 30 days. We performed univariate analysis using baseline, intraoperative and postoperative variables associated with severe postoperative complications. Selected variables (P < 0.10) were included in a forward stepwise multiple logistic regression model to identify predictive factors of a combined endpoint including 30-day mortality and severe complications.


Two hundred and fifteen patients were included in the study. The mean ejection fraction was 31%. From all patients, 129 (54.4%) presented the combined endpoint. The incidence of RBC transfusion was higher in the group with complications compared with the group without complications both intraoperative and postoperative, P < 0.001. Patients with complications were older, had lower initial hemoglobin levels and had higher EuroSCORE. At multivariate analysis, age (OR = 1.07, 95% CI = 1.013 to 1.137, P = 0.016) and perioperative RBC transfusion (OR = 7.78, 95% CI = 2.13 to 28.41, P = 0.002) were independent predictors of severe postoperative complications after cardiac surgery.


In patients with left ventricular dysfunction, red blood transfusion after cardiac surgery is a risk factor for worse outcome including 30-day mortality.

Author information



Corresponding author

Correspondence to R Miadda.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Miadda, R., Colognesi, C., Hajjar, L. et al. Red blood cell transfusion results in worse outcomes in patients with left ventricular dysfunction undergoing on-pump cardiac surgery. Crit Care 17, P366 (2013).

Download citation


  • Severe Sepsis
  • Acute Kidney Injury
  • Left Ventricular Dysfunction
  • Multiple Logistic Regression Model
  • Combine Endpoint