Retrograde autologous blood priming is an efficient technique for without, or minimally usage of blood infant cardiosurgery
Author(s):
E. V�¢rlan
Background: Both severities of cardiac surgery and technical features of extracorporeal circulation circuit demands blood transfusion from donors, which involves a number of risks for the patient, especially with low body weight. Priming of the cardiopulmonary bypass circuit with patients’ own blood [retrograde autologous priming (RAP)] is a technique used to limit haemodilution and reduce transfusion requirements.
Methods: the study included 250 children (131 boys, 119 girls) with congenital heart disease, operated on heart under CPB, weighing less than 20kg (18.45 ± 2.15) and 3.4 ± 1.7 years average age, who were divided into experimental (125 children) and control group (125children). In the control group, conventional CPB was performed (supplementing the priming with red blood cells), while in study group CPB was started after RAP via aortic cannula with recuperation till 45 % of cristaloid “priming”. The hematocrit (Hct), lactate (Lac) levels at two perioperative time-points, and intraoperative and postoperative blood usage were recorded. There were no significant differences in CPB time, aortic cross-clamp time between groups.
Results: No hospital lethality occurred in the study and no surgical hemostasis was performed. Blood loss accounted for 6.2 ml/kg /24h. Postoperative transfusion of homologous blood (erythrocyte mass) needed 73 children, that make up only 29, 2 % of the whole study group. Amongst children who received transfusion on pump, the number of packed red blood cells was less in the RAP group than that in the standard priming group intraoperatively and perioperatively (0.54 ± 0.17 vs. 1.48 ± 0.68 units, P = 0.03; 0.94 ± 0.54 vs. 1.69 ± 0.69 units, P = 0.15). There were no significant differences in CPB time, aortic clamp, and Lac value between the two groups (P>0.05). Length of ICU and hospial stay were similar.
Conclusions: “priming”minimalisation and autologous blood priming, modified ultrafiltration (MUF) could diminish the necessity of perioperative blood transfusion in infant cardiac surgery.