69. Intravenous Iron Administration Before Cardiac Surgery Reduces Red Blood Cell Transfusion in Non-Anemic Patients
Lexington VAMC
Lexington, KY
United States - Contact Me
Dr. Ferraris is a native of Bryn Mawr, Pennsylvania. He obtained his undergraduate degree from Lafayette College in Easton, Pennsylvania and entered the U.S. Army in 1965. While in the Army, he earned a doctorate in chemistry at the University of Colorado in Boulder. He served in the Viet Nam conflict where he was wounded and spent 6 months in the hospital recovering from wounds suffered in Viet Nam. He went on to complete his medical degree at Jefferson Medical College in Philadelphia while serving on active duty. Dr. Ferraris obtained postgraduate training in General Surgery and Cardiothoracic Surgery in the United States Army. After retiring from the Army Dr. Ferraris ultimately took a position at the Lexington VA Medical Center University and the University of Kentucky. He is board certified in Thoracic Surgery, General Surgery, and Surgical Critical Care. He is on the Editorial Boards of the Journal of Thoracic & Cardiovascular Surgery, and of the Annals of Thoracic Surgery, and has been appointed as an Associate Editor of the Journal of Thoracic & Cardiovascular Surgery.
Rambam Health Care Campus
Haifa, Israel
Israel - Contact Me
Tom Friedman Is a senior cardiac surgeon at Rambam Health Care Campus in Haifa, Israel. Tom received his M.D from the Technicon Medical School and completed his residency at Rambam hospital, where he was the chief resident for his last two years of residency. Tom has completed a clinical fellowship at Toronto General Hospital with a focus on heart failure and Aortic surgeries and second fellowship at Sunnybrook hospital in Toronto with a focus on Aortic surgeries. Tom's clinical interests include thoracic aortic and aortic valve surgery and mechanical assist device. During his residency, Tom was a research fellow at a research lab at the Technion faculty of medicine that dealt with the expression of cardiac proteins during cardiac stress. His researches had led to several publications in leading medical journals. Tom recently graduated an international MBA in Healthcare Innovation from the IDC University, Herzliya, Israel, in Partnership with Sheba Medical Center.
Description
Methods: A double-blind, randomized, single center, placebo-control trial conducted between Oct 2016-Nov 2019, with follow-up period of up to 6 weeks post-operation. Participants were non-anemic patients undergoing non-emergent on-pump cardiac surgery, received intravenous iron in form of FCM or placebo, administered once 24-72 hours before surgery.
Primary outcome- number of RBC units transfused during first 4 post-operative days. Secondary outcomes- Blood hemoglobin levels at 4-days and 6-weeks post-operation.
Results: We randomized 200 patients, where 194 were included, 99 patients in FCM group vs 95 in placebo group; mean age (62.9±9.1 and 62.9±9.1 respectively) and gender (87% males) equally distributed between the groups. By day 4 post-surgery, a significantly lower mean number of RBC units were transfused in FCM than placebo group (0·3±0·9 vs 1·6±4·5, respectively; p=0·006). Number of patients receiving RBCs in FCM and placebo groups was 19 (19%) and 34 (36%), respectively [OR 0·42(95%CI 0·22-0·88); p=0·01]. Mean hemoglobin levels on day 4 post-surgery were 9·7±1 g/dl vs. 9·3±1 g/dl, respectively (p=0·03). Corresponding values at 6-weeks post-surgery were 12·6±1·4 g/dl vs. 11·8±1·5 g/dl, respectively (p=0·012).
Conclusion: In non-anemic patients undergoing on-pump cardiac surgery, pre-treatment with single FCM dose of 1000 mg within 1-3 days pre-surgery significantly reduced the need for postoperative RBC transfusions and improved both serum iron level, transferrin saturation and hemoglobin levels.