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Thorac Cardiovasc Surg 2015; 63(07): 628-634
DOI: 10.1055/s-0035-1548731
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Retrograde Autologous Priming as a Safe and Easy Method to Reduce Hemodilution and Transfusion Requirements during Cardiac Surgery

Christian Trapp
1   Department of Cardiac Surgery, University of Bonn, Bonn, Germany
,
Wolfgang Schiller
1   Department of Cardiac Surgery, University of Bonn, Bonn, Germany
,
Fritz Mellert
1   Department of Cardiac Surgery, University of Bonn, Bonn, Germany
,
Maximilian Halbe
2   Division of Cardiovascular Surgery, University Hospital Zurich, Switzerland
,
Henning Lorenzen
3   Department of Informatics and Epidemiology, Institute of Medical Biometry, Bonn, Germany
,
Armin Welz
1   Department of Cardiac Surgery, University of Bonn, Bonn, Germany
,
Chris Probst
1   Department of Cardiac Surgery, University of Bonn, Bonn, Germany
› Author Affiliations
Further Information

Publication History

23 August 2014

03 February 2015

Publication Date:
24 March 2015 (online)

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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.

Patients and 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).

Conclusion 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.

Keywords

blood transfusion - cardiac - cardiopulmonary bypass - coronary artery bypass graft surgery - minimally invasive surgery - perfusion

Note

Parts of this article have previously been presented at the 43rd Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) in Freiburg, Germany, on February 10, 2014, and at the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) Annual Scientific Meeting 2014 in Boston on May 31, 2014.