Effects of priming volume reduction on allogeneic red blood cell transfusions and renal outcome after heart surgery.
BACKGROUND
Excessive hemodilution during cardiopulmonary bypass (CPB) is associated with an increased rate of red blood cell (RBC) transfusion and acute kidney injury (AKI). Minimization of the oxygenator priming volume is a measure to contain hemodilution. In this study, we evaluated the new oxygenator, Sorin Inspire 6™, with respect to its ability to limit hemodilution, RBC transfusion rate and postoperative AKI rate.


METHODS
A retrospective study on a consecutive series of 1,724 adult patients receiving heart surgery with CPB. Patients treated with the Inspire 6™ were assigned to the low priming volume oxygenator (LPVO) group (N=383) and patients treated with conventional oxygenators to the conventional group (N=1,341). Dynamic priming volume, time course of the hematocrit, RBC transfusions and AKI rate were compared between the groups.


RESULTS
Priming volume was significantly (p=0.001) lower in the LPVO group (624±113 mL) vs. the conventional group (775±150 mL), with higher values of hematocrit during and after CPB. After correction for other confounders, patients in the LPVO group had a significantly lower RBC transfusion rate (odds ratio 0.68, 95% confidence interval 0.52-0.90, p=0.006) and AKI rate (odds ratio 0.55, 95% confidence interval 0.32-0.93, p=0.032).


CONCLUSIONS
The Inspire 6™ oxygenator allows a significant containment of hemodilution during CPB, reducing the risk of RBC transfusions and postoperative AKI.
Departments of Cardiothoracic - Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy cardioanestesia@virgilio.it.
M
M
Ranucci
Departments of Cardiothoracic - Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
V
V
Pistuddi
Departments of Cardiovascular Perfusion, IRCCS Policlinico San Donato, Milan, Italy.
G
G
Carboni
Departments of Cardiovascular Perfusion, IRCCS Policlinico San Donato, Milan, Italy.
M
M
Cotza
Departments of Cardiovascular Perfusion, IRCCS Policlinico San Donato, Milan, Italy.
A
A
Ditta
Departments of Cardiovascular Perfusion, IRCCS Policlinico San Donato, Milan, Italy.
A
A
Boncilli
Departments of Cardiovascular Perfusion, IRCCS Policlinico San Donato, Milan, Italy.
S
S
Brozzi
Scientific Directorate, IRCCS Policlinico San Donato, Milan, Italy.
G
G
Pelissero
D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
acute kidney injury; cardiopulmonary bypass; hemodilution; outcome; transfusions