Red blood cell transfusion ≥ 2 units is a risk factor of long-term survival of infectious endocarditis patients with surgical intervention

Blood transfusion is common in patients with infectious endocarditis (IE) treated surgically. Limited literature on RBC transfusion outcomes in surgical IE. We aimed to clarify impacts of red blood cell (RBC) transfusion on long-term results of IE patients with surgical intervention. We conducted a retrospective study on the medical records of patients with IE undergoing cardiac surgery from 2006 to 2022 in our hospital. In our investigation, 814 IE patients were enrolled into RBC ≥ 2 units group (n = 305) and RBC < 2 units group (n = 509). There were 305 RBC ≥ 2 units patients (37.5%, 305/814). Compared with RBC < 2 units group, all-time mortality (26.2% vs 10.4%, P <.001) significantly increased in RBC ≥ 2 units group. We found vegetation diameter ≥ 10 mm, cardiopulmonary bypass length ≥ 120 minutes, aortic occlusion length ≥ 90 minutes, preoperative aortic regurgitation ≥ 4 cm2, postoperative left ventricular end diastolic diameter ≥ 70 mm, ventilation length ≥ 72 hours, ang intensive care unit stay ≥ 3 days to be related to RBC ≥ 2 units. RBC ≥ 2 units is significantly related to 1- and 5-year mortality after cardiac operation and all-time mortality. The presence of RBC ≥ 2 units in IE is a risk factor of long-term survival. In our investigation, the presence of RBC ≥ 2 units has adverse impact on long-term results of IE patients with surgical intervention. The management strategies for IE anemia may not be limited to blood transfusions, but also include drug treatments such as iron supplements and red blood cell stimulants. This study provides valuable information for clinical practice of blood transfusion in cardiac surgery.