TOPLINE:

Most patients who underwent valve surgery for infective endocarditis had anemia before surgery and received blood transfusions during their hospital stay. Red blood cell (RBC) transfusion was independently associated with an increased risk for short- and long-term mortality.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to assess how common anemia and transfusions were and how they were related to mortality after valve surgery for infective endocarditis.
• They included 2480 adults who underwent cardiac valve surgery for active infective endocarditis between January 2016 and December 2023 across 16 centers in the Netherlands. The median age of the patients was 65 years, and 77.3% were men.
• Active infective endocarditis was defined as requiring ongoing antibiotic treatment at the time of surgery. Anemia was defined according to World Health Organization criteria as a hemoglobin level < 130 g/L for men and < 120 g/L for women.
• Researchers evaluated the presence of anemia before surgery and RBC transfusions during the hospital stay. They tracked all-cause mortality at 30 days and 1 year after surgery.

TAKEAWAY:

• Anemia was present before surgery in 84.9% of patients and was more common in men than in women (85.9% vs 81.7%; P = .016).
• Overall, 78.7% of patients received RBC transfusions during hospitalization. Women had higher RBC transfusion rates than men (89.0% vs 75.6%; P < .001).
• RBC transfusion was associated with a 3.58-fold higher risk for mortality at 30 days (P < .001) and a 2.71-fold higher risk at 1 year (P < .001) after multivariable adjustment.
• Women had higher 30-day and 1-year rates of mortality than men (13.7% vs 9.7% and 21.6% vs 15.1%, respectively; both P < .01).

IN PRACTICE:

“Our findings highlight actionable areas for clinical improvement. Addressing preoperative anemia through strategies such as iron supplementation and erythropoiesis-stimulating agents may potentially reduce transfusion requirements and improve outcomes,” the researchers of the study wrote.

SOURCE:

This study was led by Jennifer S. Breel of Cardiology, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands. It was published online on December 29, 2025, in Heart.

LIMITATIONS:

The study could not determine precise timing or volume of transfusions and the disease phase when hemoglobin measurements were taken. Researchers could not account for differences between centers or regions due to limited data.

DISCLOSURES:

Several authors reported received grants from the Dutch Association of Anaesthesiologists, CSL Behring, and Octapharma Benelux. No other conflicts of interest were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.