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Blood conservation in cardiac surgery
W J Scott1, R Kessler, J A Wernly
1Division of Cardiothoracic Surgery, University of New Mexico School of Medicine, Albuquerque 87131.
Insights
This review highlights blood conservation techniques in cardiac surgery, including preoperative autologous blood donation and intraoperative processing. These methods effectively reduce the need for homologous blood transfusions, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Cardiac surgery often necessitates blood transfusions, increasing risks and costs.
- Effective blood conservation strategies are crucial for optimizing patient care and resource management.
Purpose of the Study:
- To review current blood conservation techniques applicable to cardiac surgery.
- To evaluate the efficacy and safety of various methods in reducing homologous blood use.
Main Methods:
- Review of existing literature on blood conservation in cardiac surgery.
- Analysis of techniques including preoperative autologous blood donation, intraoperative blood processing, and postoperative autotransfusion.
- Consideration of pharmacologic agents like aprotinin.
Main Results:
- Preoperative aspirin avoidance and autologous predonation are key measures.
- Intraoperative processing of withdrawn blood yields autologous platelet-rich plasma and concentrated red blood cells.
- Postoperative autotransfusion is proven safe and effective in reducing homologous blood use.
- Aprotinin mitigates plasma protein activation and platelet damage during cardiopulmonary bypass.
Conclusions:
- Integrating comprehensive blood conservation techniques can significantly decrease transfusion requirements.
- Careful consideration of transfusion indications is essential for maximizing the benefits of these strategies.
- These approaches may enable more patients to avoid transfusions entirely.
Abstract:
We reviewed current blood conservation techniques and their use in cardiac surgery. Avoidance of aspirin preoperatively is an important blood conservation measure. Patients scheduled for an elective operation should participate in autologous predonation programs. With careful monitoring, patients with major coronary artery disease can safely donate blood preoperatively. Intraoperative processing of blood withdrawn before cardiopulmonary bypass provides autologous platelet-rich plasma for infusion after reversal of heparin sodium. Blood collected from the field during operation and blood remaining in the oxygenator after bypass can also be processed to yield washed and concentrated red blood cells for reinfusion. Randomized, prospective studies document that postoperative autotransfusion is both safe and effective in reducing homologous blood use. Aprotinin reduces plasma protein activation and platelet damage during bypass. The integration of available blood conservation techniques into a comprehensive program combined with careful consideration of the indications for transfusion may allow more patients to avoid transfusion entirely.