[Benefits and limitation of extracorporeal circulation with autologous blood using low priming membrane oxygenator]

The high incidence of hepatitis following cardiopulmonary bypass has stimulated attempts to develop a technique of perfusion without homologous blood. Between October, 1987 and March, 1988, 36 patients underwent open heart surgery without homologous blood transfusion were investigated. Patients with infective endocarditis and urgent surgical cases were excluded from this study. Out of 36 patients using hemoconcentrator, autologous blood and the Variable Prime Cobe Membrane Lung (VPCML), 28 patients (78%) could avoid homologous blood transfusion during the operation and 24 patients (67%) received no homologous blood throughout their hospital stay. Thus, the application of lower volume extracorporeal oxygenator system, reinfusion of residual pump volume using hemoconcentrator and predonated autologous blood could achieved cardiac surgery without homologous blood transfusions in the majority of patients. Moreover, the VPCML had sufficient gas transfer in adult patients with body weight ranging from 37 kg to 70 kg. In renal function, serum creatinine levels in patients without homologous blood were within normal limits throughout 1 month after surgery. However, creatinine level was significantly elevated at the third postoperative day in the homologous blood transfusion group. Thus, these results suggest that application of VPCML and hemoconcentrator combined with predonated autologous blood is useful to achieve open heart surgery without donor blood.