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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?
Marek A Mak1, Adam Smołka, Jan Kowalski
1Department of Cardiac Surgery, 4 Military Clinical Hospital Centre for Heart Diseases, Wroclaw, Poland. aureliuszm@tlen.pl.
Insights
Priming cardiopulmonary bypass systems with the patient's own blood significantly reduces blood product transfusions and postoperative drain output. This innovative approach also shortens mechanical ventilation time, improving patient outcomes in cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Extracorporeal Circulation
- Transfusion Medicine
Background:
- Traditional cardiopulmonary bypass (CPB) systems require crystalloid priming.
- Reducing priming fluid volume and using autologous blood can improve patient outcomes.
Purpose of the Study:
- To compare CPB primed with autologous blood versus the standard crystalloid-primed system.
- To evaluate the impact of blood-primed CPB on perioperative outcomes in coronary artery bypass grafting (CABG).
Main Methods:
- A non-randomized trial comparing blood-primed CPB with standard crystalloid-primed CPB in CABG patients.
- Key parameters assessed included hemoglobin, hematocrit, blood product transfusion, drain output, and ventilation time.
Main Results:
- Blood-primed CPB showed significantly less decrease in hemoglobin and hematocrit.
- Reduced blood product transfusions by 75% and postoperative drain output by 28%.
- Less pronounced systemic inflammatory response and improved tissue perfusion, leading to better organ protection and shorter ventilation times.
Conclusions:
- Autologous blood-primed CPB effectively reduces postoperative hemodilution and the need for transfusions.
- This method decreases postoperative drain output and shortens mechanical ventilatory support duration.
- Blood-primed CPB offers enhanced organ and cardiac protection.
Background:
Commonly used cardiopulmonary bypass systems with cardiotomy reservoir, oxygenator, and roller pump require preoperative crystalloid filling. Radical reduction of the filling fluid volume and replacing it with the patient's own blood has a fundamental impact on the outcome.
Aim:
A comparison of cardiopulmonary bypass filled with the patient's blood, applied in Poland for the first time, and the classical system filled with crystalloids.
Methods:
Non-randomised trial in which patients undergoing coronary artery bypass grafting were divided into two groups: first operated on with use of cardiopulmonary bypass system with the patient's own blood priming, and a control group operated on with standard technique. Levels of haemoglobin (HGB), haematocrit (HCT), platelets, leukocytes, creatinine, protein, C-reactive protein, procalcitonin, volume of transfused blood products, postoperative drain output, time to extubation, and consumption of catecholamines were compared.
Results:
The results of a study comparing the classical system with the blood-filled system (n = 60) showed a significantly smaller decrease in HGB and HCT levels (p = 0.001), resulting in reduction of blood product transfusions by 75% (p = 0.03). The new type of extracorporeal circulation reduced the total postoperative drain output by approximately 28% (p = 0.003). The systemic inflammatory response syndrome (SIRS) was less pronounced and the tissue perfusion was better due to smaller degree of haemodilution leading to better organ and heart protection. The patients required shorter mechanical ventilation times in the perioperative period.
Conclusions:
The use of a new system of cardiopulmonary bypass filled with the patient's blood reduces the postoperative decrease in HGB and HCT, the amount of transfused blood products, and total postoperative drain output. It also shortens the time spent on mechanical ventilatory support.
