Low-prime perfusion circuit and autologous priming in CABG surgery on a Jehovah's Witness: a case report.
Cardiac surgery on Jehovah's Witnesses is a great challenge for the cardiothoracic surgery team and especially for the perfusionist. To reduce the risk of surgery in these patients, a very small extracorporeal circuit was designed to decrease the amount of priming volume and thereby the degree of hemodilution. A small bypass system was built, consisting of a 3/8-in. arterial line and a 3/8-in. venous line, a venous collapsible reservoir, a centrifugal pump, a hollow fiber oxygenator and a cell saver reservoir. The circuit priming volume was 650 ml. By using antegrade and retrograde autologous priming, the total amount of priming was reduced to +/-50 ml. Bypass time was 63 min with an average blood flow of 5300+/-114 ml/min and postmembrane pressures of 180+/-45 mmHg. Venous line pressure was monitored and kept between -8 and -20 mmHg with a mean arterial pressure (MAP) of 55+/-12.3 mmHg. The hematocrit before extracorporeal circulation (ECC) was 36%, per-ECC 35% and post-ECC 35%. On the fifth postoperative day, the hematocrit was 40%. The patient was discharged 7 days after surgery. A low-prime circuit, in combination with autologous priming, seems to be safe and effective in avoiding the use of banked blood.
Brest van Kempen
A B
AB
Department of Extracorporeal Circulation, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. r.brestvankempen@planet.nl
Gasiorek
J M
JM
Bloemendaal
K
K
Storm van Leeuwen
R P H
RP
Bulder
E R
ER
D000328:Adult; D002315:Cardiopulmonary Bypass / Q000295:instrumentation; D001026:Coronary Artery Bypass / Q000295:instrumentation; D004867:Equipment Design; D005112:Extracorporeal Circulation / Q000295:instrumentation*; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male; D016896:Treatment Outcome