A New PRECiSe (Priming Reduced Extracorporeal Circulation Setup) Minimizes the Need for Blood Transfusions: First Clinical Results in Coronary Artery Bypass Grafting
DOI:
https://doi.org/10.1532/HSF98.20041065Abstract
Hemodilution by the crystalloid priming volume of standard heart-lung machines in cardiac surgery is associated with impaired organ function and increased blood transfusion requirements. The aim of this study was to evaluate the effect of the use of the newly developed priming reduced extracorporeal circulation setup (PRECiSe) on perioperative hemodilution and transfusion requirements. In a matched prospective study, 40 patients who underwent operations with the PRECiSe in elective primary coronary artery bypass surgery were compared with 40 patients who underwent operations with the standard heart-lung machine. A significant reduction in final priming volume resulted in a significantly reduced degree of hemodilution and transfusion requirements during and after extracorporeal circulation. In the PRECiSe group, only 10% of the patients needed transfusions during their hospital stay, whereas 35% of the patients in the control group required any transfusion (P < .05). The average transfusion per patient was 0.16 units in the PRECiSe group and 1.25 units in the control group (P < .05). The PRECiSe was demonstrated to be safe and effective in coronary artery bypass surgery with respect to transfusion requirements and hemodilution, as well as with regard to patient safety, as represented by perioperative myocardial performance.References
Beholz S, Kessler M, Thölke R, Konertz W. 2003. PRECiSe (priming reduced extracorporeal circulation setup) with the DeltaStream diagonal pump. Artif Organs 27:1110-5.nBeholz S, Koch C, Konertz W. 2003. Quality management system of a university cardiac surgery department according to DIN EN ISO 9001: 2000. Thorac Cardiovasc Surg 51:167-73.nBeholz S, Konertz W. 2002. Minimally invasive coronary revascularization: current status and outlook to the future [in German]. Chirurgische Praxis 60:687-700.nBenetti FJ, Geffner L, Naselli G, Wood M. 1991. Direct myocardial revascularization without extracorporeal circulation: experience in 700 patients. Chest 100:312-6.nCalafiore AM, Teodori G, Mezzetti A, et al. 1995. Intermittent antegrade warm blood cardioplegia. Ann Thorac Surg 59:398-402.nDietrich W, Lüth JU, Kormann J, et al. 1999. Intraoperative blood requirements and allogeneic blood transfusion in cardioanesthesia: data analysis of 7729 patients in 12 cardiac surgical clinics [in German]. Anaesthesist 48:876-83.nFang WC, Helm RE, Krieger KH, et al. 1997. Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation 96:II-194-9.nFolliguet TA, Villa E, Vandeneyden F, Laborde F. 2003. Coronary artery bypass graft with minimal extracorporeal circulation. Heart Surg Forum 6:297-301.nFromes Y, Gaillard D, Ponzio O, et al. 2002. Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothorac Surg 22:527-33.nGibbon JH Jr. 1954. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med 37:171-85.nGravlee GP, Davis RF, Kurusz M, Utley JR, eds. 2000. Cardiopulmonary bypass. Philadelphia, Pa: Lippincott Williams & Wilkins. Hardy JF, Martineau R, Couturier A, Belisle S, Cartier R, Carrier M. 1998. Influence of haemoglobin concentration after extracorporeal circulation on mortality and morbidity in patients undergoing cardiac surgery. Br J Anaesth 81(suppl 1):38-45.nKalmar P, Irrgang E; German Society for Thoracic and Cardiovascular Surgery. 2003. Cardiac surgery in Germany during 2002: a report by German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 51:25-9.nMack MJ. 2003. Advances in the treatment of coronary artery disease. Ann Thorac Surg 76:S2240-5.nNollert G, Sperling J, Sakamoto T, Jaeger BR, Jonas RA. 2001. Higher hematocrit improves liver blood flow and metabolism during cardiopulmonary bypass in piglets. Thorac Cardiovasc Surg 49:226-30.nRoques F, Nashef SAM, Gauducheau E, et al. 1999. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 15:816-23.nSwaminathan M, Phillips-Bute BG, Conlon PJ, Smith PK, Newman MF, Stafford-Smith M. 2003. The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery. Ann Thorac Surg 76:784-91.nBeholz S, Kessler M, Thölke R, Konertz W. 2003. PRECiSe (priming reduced extracorporeal circulation setup): results of a safety study. Heart Surg Forum 6:311-5.n
