Comparison of the effects of a cell saver and low-dose aprotinin on blood loss and homologous blood usage in patients undergoing valve surgery.
OBJECTIVE
To compare 2 important techniques of blood conservation, use of a cell saver and low-dose aprotinin, in terms of blood loss and homologous blood usage in patients undergoing cardiac valve surgery.


METHODS
Prospective, randomized.


METHODS
Tertiary care hospital.


METHODS
Sixty adult patients undergoing elective valve surgery.


METHODS
The patients were divided into 3 groups of 20 each. In group 1, aprotinin in the dose of 30,000 KIU/kg was added to the pump prime, with a further dose of 15,000 KIU/kg added at the end of each hour of cardiopulmonary bypass. In group 2, a cell-saver system was used to collect all blood at the operation site for processing in preparation for subsequent reinfusion. Group 3 patients acted as a control group and underwent routine management, which included collection of autologous blood during the pre-cardiopulmonary bypass period. A hemoglobin of <8 g/dL was considered as an indication for bank blood transfusion in the postoperative period.


RESULTS
The chest tube drainage was significantly less in group 1 compared with groups 2 and 3, with total drainage (median [interquartile range]) amounting to 250 mL [105 to 325 mL] vs. 700 mL [525 to 910 mL] in group 2 and 800 mL [650 to 880 mL] in group 3 (p < 0.001). The patients in groups 1 and 2 required significantly less bank blood (median [interquartile range]) as compared with group 3 (350 mL [0 to 525 mL], 350 mL [0 to 350 mL], and 1050 mL [875 to 1050 mL]; p < 0.001), respectively. Cell saver provided 410 +/- 130 mL of hemoconcentrated blood in group 2. The average preoperative hemoglobin concentration was 11.3 g/dL, and it was around 9 g/dL on the 7th postoperative day. The hemoglobin concentration at various stages during hospitalization in all 3 groups was similar.


CONCLUSIONS
Low-dose aprotinin and a cell saver are effective and comparable methods of blood conservation. Aprotinin helps by decreasing the postoperative drainage, and a cell saver helps by making the patient's own blood available for transfusion.
Tempe
D K
DK
Departments of Anaesthesiology and Cardiothoracic Surgery, G. B. Pant Hospital, New Delhi, India.
Banerjee
A
A
Virmani
S
S
Mehta
N
N
Panwar
S
S
Tomar
A S
AS
Ghambeer
D K
DK
Nigam
M
M
D000328:Adult; D007611:Aprotinin / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous; D004322:Drainage; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006454:Hemoglobins / Q000378:metabolism; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007194:India; D008297:Male; D010976:Platelet Count; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000601:surgery; D014914:Whole Blood Coagulation Time
D006454:Hemoglobins; D006490:Hemostatics; D007611:Aprotinin