Abstract
OBJECTIVES: This study aims to compare intraoperative blood transfusion and perioperative outcomes for patients undergoing left ventricular assist device (LVAD) implantation before and after the implementation of a blood conservation protocol. METHODS: This retrospective cohort study included patients who underwent LVAD implantation from June 2017 to October 2024 at our Hospital. The primary outcome was total intraoperative transfusion volume, and secondary outcomes included intraoperative transfusion volume and rates of red blood cells (RBC), fresh frozen plasma (FFP), platelets, and reoperation due to bleeding. Exploratory outcomes included mortality and serious complications before hospital discharge. RESULTS: In total, 120 patients were included, with 62 receiving traditional care and 58 treated with blood conservation protocol. After protocol implementation, total intraoperative transfusion volume decreased from 3.23 ± 3.24 units to 1.74 ± 1.56 units (P = 0.002). The intraoperative RBC transfusion rate dropped from 30.6% to 8.6% (P = 0.003), and the transfusion volume fell from 1.00 ± 1.71 units to 0.31 ± 1.05 units (P = 0.009). In multivariate analysis, the protocol was significantly associated with reduced total intraoperative transfusion volume, lower RBC transfusion volume and rate, and shorter ICU and hospital stays, while not correlated with perioperative mortality or serious complications. CONCLUSIONS: The blood conservation protocol significantly reduced intraoperative transfusion in LVAD patients and expedited recovery.