title: Retrograde autologous prime with shortened bypass circuits decreases blood transfusion in high-risk coronary artery surgery patients.
abstract: Previous studies have shown that minimizing the amount of hemodilution during open-heart surgery reduces the need for a blood transfusion. Transfusion increases a patient's medical risks and leads to increased costs. We used a shortened bypass circuit, primed with autologous blood in a retrograde fashion, to decrease red cell transfusion in high-risk patients. One hundred twenty-three patients having first-time, nonemergent coronary artery surgery were chosen for this trial, based on their low prebypass hematocrit and weight. In seventy-two cases, we used a shortened bypass circuit and retrograde autologous prime. A historical control group of fifty-one patients received a standard bypass circuit and prime method. The prebypass hematocrit was 35 +/- 2.62% and 34 +/- 2.99% in the control and study groups, respectively. Red blood cell transfusion was necessary in 70% of the control group during their hospital stay, whereas only 51.4% of the study group required transfusion (p = .006). Patients receiving no blood products were significantly higher in the study group, 48.6% vs. 30.0% (p = .005). The postbypass hematocrit was similar at 26.5 +/- 1.82% vs. 25.5 +/- 2.38%, and the discharge hematocrit was 30.8 +/- 3.33% and 31.2 +/- 3.04% in the control and study groups. respectively. Minimizing hemodilution by shortening the bypass circuit and performing retrograde autologous prime conserves the use of blood during routine coronary artery bypass surgery. These methods can be used for patients who are at greater risk for transfusion.
authors.affiliation: Heart and Vascular Institute, Providence Everett Medical Center, Everett, Washington, USA. ezelinka@cedarcomm.com
authors.forename: Edy S
authors.initials: ES
authors.lastname: Zelinka
authors.forename: Patrick
authors.initials: P
authors.lastname: Ryan
authors.forename: Julie
authors.initials: J
authors.lastname: McDonald
authors.forename: James
authors.initials: J
authors.lastname: Larson
mesh_terms: D000368:Aged; D001804:Blood Transfusion, Autologous / Q000295:instrumentation / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods*; D005112:Extracorporeal Circulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006400:Hematocrit; D006438:Hemodilution / Q000379:methods*; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D000077331:Ringer's Solution; D012307:Risk Factors
chemical_list: D007552:Isotonic Solutions; D000077331:Ringer's Solution