Reinfusion of mediastinal blood after heart surgery.
BACKGROUND
Several authors studying autotransfusion of shed mediastinal blood in patients undergoing heart operations have published conflicting results regarding reduction of the need for homologous blood transfusion. The effect on coagulation parameters is also unclear.


METHODS
In a prospective randomized study, 198 patients who underwent coronary artery bypass grafting or a valvular operation were divided into 2 groups: a group with autotransfusion of shed mediastinal blood after an operation and a control group. Continuous reinfusion of mediastinal blood was done until no drainage was present or for a period of 12 hours after the operation. The amount of blood lost and autotransfused, the number of homologous blood products transfused, and the coagulation parameters were monitored.


RESULTS
The number of patients requiring homologous blood transfusion was significantly different between the 2 groups (54/98 [55%] in autotransfused patients vs 73/100 [73%] in the control group, P =.01). The number of re-explorations for excessive bleeding was similar in the 2 groups (7/98 [7.1%] vs 8/100 [8%]), but the amount of blood collected postoperatively was higher in the autotransfused patients compared with control patients (1200 +/- 201 mL vs 758 +/- 152 mL, P =.0007). Coagulation parameters analyzed and complication rates were similar in the 2 groups after the operations.


CONCLUSIONS
Autotransfusion of shed mediastinal blood reduces the need for homologous blood transfusion in patients undergoing various cardiac operations. The cause of increased shed blood in patients undergoing autotransfusion remains unclear.
Martin
J
J
Departments of Surgery and Anesthesia and the Laboratory of Hematology, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada.
Robitaille
D
D
Perrault
L P
LP
Pellerin
M
M
Pagé
P
P
Searle
N
N
Cartier
R
R
Hébert
Y
Y
Pelletier
L C
LC
Thaler
H T
HT
Carrier
M
M
D000704:Analysis of Variance; D016913:Blood Component Transfusion; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous / Q000379:methods*; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000098:blood supply; D008875:Middle Aged; D011446:Prospective Studies