Effect of preoperative intravenous iron therapy on transfusion requirements and morbidity in adult patients undergoing open heart surgery

Objective: This study compared postoperative transfusion requirements, morbidity and mortality between adult cardiac surgery patients with preoperative anemia treated with intravenous ferric carboxymaltose and non-anemic patients.Methods: This was a prospective study including 95 patients undergoing elective open heart surgery with cardiopulmonary bypass between April 2019 and April 2022. Twenty-five (26.3%) patients had preoperative iron deficiency anemia and received intravenous ferric carboxymaltose (1000 mg, with an additional 500 mg if indicated preoperatively based on BMI). Seventy patients were non-anemic controls. Transfusion criteria were based on hemoglobin < 7–8 g/dL, hemodynamic instability, or clinical judgment. Statistical analyses included Student’s t-test, Mann–Whitney U, Chi-square or Fisher’s exact tests with p 0.05). The mean operation time was shorter in the anemic treated group, partly reflecting a lower CABG rate. Baseline demographics were similar across groups (mean age 61.6 ± 11.0 vs 60.2 ± 15.9 years).Conclusion: Preoperative intravenous iron therapy in anemic patients did not reduce postoperative transfusion needs but allowed outcomes comparable to non-anemic patients. Intravenous (IV) iron therapy was safe, and patients experienced similar ICU and hospital courses. Larger randomized controlled trials are required to confirm efficacy.