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[Autologous transfusion in heart surgery (apropos of 74 patients)]
V Deramoudt1, P Menestret, Y Melledant
1Département d'Anesthésie-Réanimation, CHU Pontchaillou, Rennes.
Insights
This study compared autotransfusion methods in heart surgery. Postoperative autotransfusion alone effectively reduced the need for donor blood transfusions in patients with significant bleeding.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Autotransfusion is a method to reduce the need for donor blood in surgery.
- Different autotransfusion techniques exist, but their comparative efficacy in heart surgery requires further investigation.
Purpose of the Study:
- To compare three autotransfusion techniques in heart surgery under extracorporeal circulation (ECC).
- To evaluate the effectiveness of autotransfusion in reducing homologous red cell concentrate requirements, particularly in patients with substantial blood loss.
Main Methods:
- Three groups of patients undergoing heart surgery were studied: Group I (peroperative/post-ECC transfusion), Group II (postoperative transfusion of extravasated thoracic blood), and Group III (combination of both techniques).
- Patients were monitored for postoperative bleeding and homologous red cell concentrate usage.
- A subgroup of patients with >1 liter blood loss was analyzed separately.
Main Results:
- Postoperative bleeding was similar across all three autotransfusion groups.
- Patients undergoing autotransfusion required fewer homologous red cell concentrates compared to controls (2.4 vs. 5.7, p<0.05).
- Group II (postoperative autotransfusion) showed a particularly marked reduction in homologous red cell concentrate needs (1.9 concentrates).
Conclusions:
- Postoperative autotransfusion alone is effective in reducing homologous red cell concentrate requirements in heart surgery patients with significant bleeding.
- Combining peroperative and postoperative autotransfusion techniques does not offer additional benefits over postoperative autotransfusion alone.
- All evaluated autotransfusion techniques were safe and well-tolerated, with no reported side-effects.
Abstract:
The present study uses three techniques of autotransfusion in heart surgery under ECC: peroperative and post-ECC transfusion of blood removed after induction of anaesthesia (group I: 25 patients); postoperative transfusion of extravasated thoracic blood (group II: 24 patients) and a combination of the two (group III: 25 patients). Postoperative bleeding was comparable in all groups; A subset likely to haemorrhage made up of patients who had lost more than one litre of blood was isolated and demonstrated a reduction in the number of homologous red cell concentrates needed for the autotransfused population in comparison with the controls (2.4 +/- 2.6 vs 5.7 +/- 3.5 red cell concentrates, p less than 0.05) and was particularly marked in Group II patients who received 1.9 +/- 2.2 homologous red cell concentrates. None of the techniques caused any side-effects. Combination of the two autotransfusion techniques in heart surgery does not secure any additional advantages compared with postoperative autotransfusion alone.