Comparison of Transfusion Requirements for Conventional and Miniaturized Extracorporeal Circuits
DOI:
https://doi.org/10.1532/HSF98.20071162Abstract
Objective. Hemodilution is a well-recognized phenomenon of cardiopulmonary bypass (CPB). The degree of hemodilution has attendant risks. As the degree of hemodilution increases, red blood cell transfusions may be necessary, and the risks of blood transfusions are becoming very well recognized. Blood-conservation programs are being developed worldwide to establish strategies to reduce transfusions. Miniaturized extracorporeal circuits (MECs) are associated with less hemodilution than conventional CPB circuits. The use of MECs can be expected to be associated with fewer red blood cell transfusions.
Methods. The first 250 patients who underwent coronary artery bypass grafting, aortic valve replacement, or both with the use of a MEC were compared with 200 consecutive patients who had similar comorbidities and types of surgery but underwent their operations on a conventional bypass circuit. These surgeries were completed between April 2004 and September 2005 under the care of the same surgical team. The minimum acceptable hematocrit on bypass was 22%. Intra- and postoperative transfusion rates were measured and compared.
Results. For conventional bypass, the intraoperative transfusion rate was 36.5%, whereas the rate for the MEC was 23.3%. The postoperative transfusion rate was 55% for operations performed with conventional bypass and 26% for the MEC. The overall in-hospital transfusion rate for conventional bypass was 63% and 36% for the MEC.
Conclusions. The data indicate that use of MECs leads to a lower transfusion rate than in surgeries in which conventional CPB is used.
References
Abdel-Rahman U, Ozaslan F, Risteski PS, et al. 2005. Initial experience with a minimized extracorporeal bypass system: is there a clinical benefit? Ann Thorac Surg 80:238-44.nBeghi C, Nicolini F, Agostinelli A, et al. 2006. Mini-cardiopulmonary bypass system: results of a prospective randomized study. Ann Thorac Surg 81:1396-400.nEngoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ. 2002. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg 74:1180-6.nFerraris V, Ferraris SP, Saha SP, et al. 2004. Peri-operative blood transfusion and blood conservation in cardiac surgery. Soc Thorac Surgeons 2004;1:1-113.nFolliguet TA, Villa E, Vandeneyden F, Laborde F. 2003. Coronary artery bypass graft with minimal extracorporeal circulation. Heart Surg Forum 6:297-301.nGoldman S, Sutter F, Ferdinand F, Trace C. 2004. Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients. Heart Surg Forum 5:E376-81.nHelm RE, Rosengart TK, Gomez M, et al. 1998. Comprehensive multimodality blood conservation: 100 consecutive CABG operations without transfusion. Ann Thorac Surg 65:125-36.nKoch C, Khandwala F, Li L, Estafanous FG, Loop FD, Blackstone EH. 2006. Persistent effect of red cell transfusion on health related quality of life after cardiac surgery. Ann Thorac Surg 82:13-20.nLeal-Noval SR, Marquez-Vácaro J, García-Curiel A, et al. 2000. Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med 28:935-40.nMichalopoulos A, Starvridis, Geroulanos S. 1998. Severe sepsis in cardiac surgical patients. Eur J Surg 164:217-22.nNollert G, Schwabenland I, Maktav D, et al. 2005. Miniaturized cardiopulmonary bypass in coronary artery bypass surgery: marginal impact of inflammation and coagulation but loss of safety margins. Ann Thorac Surg 80:2326-32.nRanucci M, Pavesi M, Mazza E, et al. 1994. Risk factors for renal dysfunction after coronary surgery: the role of cardiopulmonary bypass technique. Perfusion 9:319-26.nZacharias A, Habib RH. 1996. Factors predisposing to median sternotomy complications: deep vs superficial infection. Chest 110:1173-8.n
