Mini-cardiopulmonary bypass impact on blood conservation strategy in coronary artery bypass grafting.
OBJECTIVE
Cardiopulmonary bypass (CPB) using a closed circuit system with minimal priming volume can be a solution to ameliorate adverse effects of CPB. We hypothesize that the use of mini-bypass in routine coronary artery bypass grafting (CABG) reduces homologous blood product use and postoperative bleeding. The study is designed to determine the differences in blood loss and transfusion requirements associated with a minimized CPB circuit vs. a standard bypass circuit.


METHODS
From February 2009 to August 2009, 80 patients were prospectively randomized to undergo elective CABG. Group A included 40 patients who had the minimized bypass circuit (Medtronic Resting Heart Circuit). Group B had an equal number of patients who had the standard CPB circuit (Stockert III, SEC.BM). Laboratory parameters for hemoglobin, hematocrit and platelet count were measured at baseline after initiation of CPB and after bypass. Blood usage was controlled by study-specific protocol (transfusion for hemoglobin <8 g/dl). Records were kept for blood products. The chest and mediastinal drainage was monitored for the first 24 postoperative hours. Ventilation time, inotropic use and intensive care unit (ICU) stay was compared in both groups.


RESULTS
There were no statistical differences in terms of patients' demographics. Statistically significant differences were seen in transfused red blood cells volume (1.47±1.13 units in group A vs. 2.05±1.19 in group B, P<0.05), fresh frozen plasma (2.5±1.62 unit vs. 3.55±2.58 units, P<0.001), platelets (1.95±2.95 units vs. 3.23±2.85), and postoperative drainage in 24 hours (531.62±220.12 ml vs. 729±294.9 ml, P<0.05). The hematocrit was 33±5% in group A, and 27±1% in group B. There was statistical differences seen in the mean hemoglobin level which was 10.19±0.65 g/dl in group A, and 9.4±0.68 g/dl in group B. There was statistical difference in the duration of ventilation, length of ICU stay. The requirement of inotropic support was lower in group A.


CONCLUSIONS
The adoption of mini-bypass significantly reduces morbidity including donor blood usage and postoperative bleeding in routine CABG patients.
King Fahad Cardiac Center and College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. malaal2@hotmail.com
Mohamed
M
Abdel Aal
Nezar
N
ElNahal
Bakir Moustafa
BM
Bakir
Mohamed
M
Fouda
D000368:Aged; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D006400:Hematocrit; D006438:Hemodilution; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012529:Saudi Arabia; D013997:Time Factors; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D006454:Hemoglobins