Abstract: Objective To investigate the associations of preoperative anemia correction strategy and hemoglobin (Hb) correction magnitude with the risk of all-cause mortality within 30 days following discharge in anemic patients undergoing cardiac valve surgery. Methods We retrospectively analyzed the clinical data of 369 adult patients with anemia defined according to the World Health Organization criteria who underwent primary cardiac valve surgery under cardiopulmonary bypass at Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University between January 2020 and December 2022. Patients were categorized according to preoperative anemia correction strategy and Hb correction magnitude. Propensity score matching (PSM) was used to balance baseline characteristics. Univariate and multivariate Logistic regression analyses were performed to evaluate risk factors for 30-day all-cause mortality after discharge. According to the Hb correction value, patients were classified into four groups:<-10, -10 to <0, 0 to <15, and≥15 g/L, and the association between different correction magnitudes and mortality was assessed. Results After PSM, the transfusion correction group showed a trend toward a higher risk of 30-day all-cause mortality than the pharmacological correction group. The difference was not statistically significant, although a potential clinically relevant trend was observed (aOR=3.038, 95%CI 0.909~10.152, P=0.071). After stratification by Hb correction value, the 30-day all-cause mortality rates in the four groups were 21.7%, 4.5%, 11.7%, and 33.3%, respectively; and the difference was statistically significant (P=0.04). The mortality risk tended to show a U-shaped distribution with the change in correction amplitude. In addition, age was an independent risk factor for 30-day all-cause mortality after discharge (aOR=1.097, 95%CI: 1.042~1.155, P<0.001). Conclusion The correction strategy and correction amplitude of preoperative anemia may be associated with short-term prognosis in patients undergoing heart valve surgery. In perioperative patient blood management, pharmacological correction based on etiology may be a preferable option, and close attention should be paid to the magnitude of Hb change to avoid the potential adverse prognosis associated with under-correction or over-correction.

Key words: Cardiac valve surgery, Preoperative anemia, Anemia correction strategy, Hemoglobin correction value, Propensity score matching, Patient blood management