title: Retrograde Autologous Priming as a Safe and Easy Method to Reduce Hemodilution and Transfusion Requirements during Cardiac Surgery.
abstract: BACKGROUND
  During the last decades many efforts have been made to reduce transfusion requirements and adverse clinical effects during cardiopulmonary bypass (CPB). The minimal extracorporeal circulation (MECC) system and the technique of retrograde autologous priming (RAP) of a conventional CPB circuit have been associated with decreased hemodilution. Our study aimed to compare conventional CPB (cCPB), RAP, and the ROCsafe MECC (Terumo Europe N.V., Leuven, Belgium) system in elective coronary artery bypass patients.
  
  
  METHODS
  Data were retrospectively collected on three cohorts of 30 adult CPB patients. Patients were operated using cCPB, RAP, and the ROCsafe MECC system.
  
  
  RESULTS
  The three groups were comparable in demographic data. The priming volume in the ROCsafe and RAP group was significantly less compared with the conventional priming group (p <0.05). The mean time of extracorporeal circulation and aortic cross-clamp time (p <0.05) were significantly shorter in the ROCsafe group. The levels of hemoglobin (Hb) and hematocrit (Hct) during CPB and postoperatively showed significant differences between the three groups (p < 0.05) and resulted in significantly higher blood transfusion requirements (p < 0.05). Lactate, serum creatinine, troponin, and creatine kinase-myocardial band (CK-MB) levels did not differ significantly among the three groups (p >0.05). There was also no statistically significant difference in ventilation time, intensive care unit (ICU) stay, overall hospital stay, and postoperative complications (p >0.05).
  
  
  CONCLUSIONS
  In conclusion, RAP is compared with cCPB and MECC a safe and low-cost technique in reducing the priming volume of the CPB system, causes less hemodilution, and reduces the need for intra- and postoperative blood transfusion.
authors: Department of Cardiac Surgery, University of Bonn, Bonn, Germany.
authors: Christian
authors: C
authors: Trapp
authors: Department of Cardiac Surgery, University of Bonn, Bonn, Germany.
authors: Wolfgang
authors: W
authors: Schiller
authors: Department of Cardiac Surgery, University of Bonn, Bonn, Germany.
authors: Fritz
authors: F
authors: Mellert
authors: Division of Cardiovascular Surgery, University Hospital Zurich, Switzerland.
authors: Maximilian
authors: M
authors: Halbe
authors: Department of Informatics and Epidemiology, Institute of Medical Biometry, Bonn, Germany.
authors: Henning
authors: H
authors: Lorenzen
authors: Department of Cardiac Surgery, University of Bonn, Bonn, Germany.
authors: Armin
authors: A
authors: Welz
authors: Department of Cardiac Surgery, University of Bonn, Bonn, Germany.
authors: Chris
authors: C
authors: Probst
mesh_terms: D000368:Aged; D001804:Blood Transfusion, Autologous; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods*; D002318:Cardiovascular Diseases / Q000601:surgery; D001026:Coronary Artery Bypass / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery; D017558:Elective Surgical Procedures; D005260:Female; D006400:Hematocrit; D006438:Hemodilution / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome