Coronary artery surgery: cardiotomy suction or cell salvage?
Coronary artery bypass grafting (CABG) today results in what may be regarded as acceptable levels of blood loss with many institutions avoiding allogeneic red cell transfusion in over 60% of their patients. The majority of cardiac surgeons employ cardiotomy suction to preserve autologous blood during on-pump coronary artery bypass surgery; however the use of cardiotomy suction is associated with a more pronounced systemic inflammatory response and a resulting coagulopathy as well as exacerbating the microembolic load. This leads to a tendency to increased blood loss, transfusion requirement and organ dysfunction. Conversely, the avoidance of cardiotomy suction in coronary artery bypass surgery is not associated with an increased transfusion requirement. There is therefore no indication for the routine use of cardiotomy suction in on-pump coronary artery surgery.
Lau
Kelvin
K
Department of Cardiac Surgery, Royal Brompton Hospital, and NHLI at Imperial College, London SW3 6NP, UK. kelvin.lau@uhl-tr.nhs.uk
Shah
Hetul
H
Kelleher
Andrea
A
Moat
Neil
N
D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000379:methods*; D002469:Cell Separation / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004617:Embolism / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007430:Intraoperative Care / Q000009:adverse effects / Q000379:methods*; D013396:Suction / Q000009:adverse effects*; D016896:Treatment Outcome
D018836:Inflammation Mediators