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February 8, 2026European Heart Journal

The safe hematocrit threshold during cardiopulmonary bypass in children with cyanotic congenital heart disease: a retrospective study

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Key result

Nadir hematocrit >30% during CPB is linked to ~46% lower AKI risk vs <25%.

  • OR 0.54
  • 95% CI 0.40-0.74
  • P<0.001
  • n=3,158

Why the study?

Does maintaining a higher intraoperative nadir hematocrit reduce the risk of AKI and composite complications in children under 14 years old with cyanotic congenital heart disease undergoing cardiopulmonary bypass?

Population

3158 children under 14 years old with cyanotic congenital heart disease who underwent cardiopulmonary bypass…

Comparison

Intraoperative nadir hematocrit 25%-30% or >30% vs Intraoperative nadir hematocrit (Hct) <25%

Design

Cohort

Authors

QLQ D LiuChinese Academy of Medical Sciences & Peking Union Medical CollegeTGT Y GaoChinese Academy of Medical Sciences & Peking Union Medical CollegeJLJ P LiuChinese Academy of Medical Sciences & Peking Union Medical College

Discussion

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Implication

In children with cyanotic congenital heart disease undergoing cardiopulmonary bypass, maintaining an intraoperative nadir hematocrit above 25% is associated with a lower risk of acute kidney injury and composite complications.

Key Points

  • This research aims to identify the safe hematocrit (Hct) threshold for children with cyanotic congenital heart disease (CCHD) during cardiopulmonary bypass to minimize complications.
  • Single-center retrospective analysis of children under 14 years with CCHD undergoing CPB cardiac surgery
  • Patients stratified by nadir Hct levels: <25%, 25%-30%, and >30%
  • Data collected on demographics, hemodynamic parameters, surgical details, and transfusion requirements
  • Primary outcomes included acute kidney injury and composite complications; secondary outcomes focused on blood product transfusion rates.
  • 3158 children were analyzed; absolute nadir Hct values were <25% in 50.7%, 25%-30% in 27.8%, >30% in 21.5%
  • Higher intraoperative Hct was linked to reduced risks of AKI and composite complications, with statistically significant odds ratios for both 25%-30% and >30% categories
  • Increased need for RBC transfusions was noted with lower Hct; however, nadir Hct >30% correlated with increased FFP transfusion rates and total blood product needs.

Study Design

Type

Cohort (n=3,158)

Multicenter

No

Structured PICO

Does maintaining a higher intraoperative nadir hematocrit reduce the risk of AKI and composite complications in children under 14 years old with cyanotic congenital heart disease undergoing cardiopulmonary bypass?

P
Population
3,158 children under 14 years old with cyanotic congenital heart disease undergoing cardiopulmonary bypass cardiac surgery.
E
Exposure
Intraoperative nadir hematocrit (Hct) 25%-30% or >30%
C
Comparator
Intraoperative nadir hematocrit (Hct) <25%
O
Outcome
Incidence of acute kidney injury (AKI) and composite complications (AKI, prolonged mechanical ventilation, surgical re-exploration, pulmonary infection, ECMO implantation, liver injury, and in-hospital mortality)composite

Main Result

Odds Ratio: 0.54 (95% CI 0.4–0.74)

p-value: p=<0.001

In children with cyanotic congenital heart disease undergoing cardiopulmonary bypass, maintaining an intraoperative nadir hematocrit above 25% is associated with a lower risk of acute kidney injury and composite complications.

Cite This Study

Liu et al. (2025) conducted a cohort in Cyanotic congenital heart disease (n=3,158). Intraoperative nadir hematocrit >30% vs. Intraoperative nadir hematocrit <25% was evaluated on Acute kidney injury (AKI) (OR 0.54, 95% CI 0.40-0.74, p=<0.001). Intraoperative nadir hematocrit >30% during cardiopulmonary bypass was associated with a reduced risk of acute kidney injury compared to <25% (OR 0.54; 95% CI 0.40-0.74; P<0.001).

synapsesocial.com/papers/698827a20fc35cd7a8846734https://doi.org/10.1093/eurheartj/ehaf784.4032
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Quality management of comprehensive blood conservation strategies during cardiopulmonary bypass in pediatric cardiac surgery2026
  2. 2Exploring the effects of hemodialyzers on clinical outcomes in pediatric cardiac surgery during cardiopulmonary bypass: a retrospective cohort study2025 · 1 citations
  3. 3Postoperative Hematocrit and Lactate Trajectory After Neonatal Cardiopulmonary Bypass: A Retrospective Cohort Study2026
  4. 4OR12-7 | Reducing Red Blood Cell Transfusions Following Pediatric Cardiac Catheterization2024
  5. 5Quantitative and functional changes in platelets and fibrinogen following cardiopulmonary by-pass in children2024 · 1 citations