Evaluation of autotransfusion in elective aortic reconstruction

A new intraoperative autotransfusion system was prospectively evaluated in 30 major aortic reconstructions. After systemic heparinization of the patient, blood is collected in a cardiotomy reservoir and immediately reinfused (up to 500 ml/min). The amount of autotransfused or banked blood necessary to maintain the hemoglobin at 100 g/L during and for 24 hours after surgery was monitored and coagulation profiles, renal function and complications were recorded. The amount of autotransfused blood averaged 1414 ml and the number of packed red blood cells transfused over 24 hours averaged 1.9 units. Of the 30 patients, 24 required 2 units of homologous blood or less over 24 hours; 8 patients received no homologous transfusions and another 8 only 1 unit. There was no significant change postoperatively in serum creatinine or fibrinogen levels or in the prothrombin and partial thromboplastin times; the platelet count fell from 264 x 10(9)/L preoperatively to 182 x 10(9)/L postoperatively (p less than 0.05), but this was not clinically relevant. The free plasma hemoglobin level rose substantially, but perioperative urine output was good. There were no complications attributable to autotransfusion. The use of the autotransfuser during major vascular surgery provides a safe, effective means to minimize the loss of clotting factors, preserve blood-bank resources and eliminate the risk of disease transmission from homologous blood. By allowing rapid reinfusion when blood loss is excessive, this system can prevent prolonged hypotension in patients at increased cardiac risk.