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Autologous blood donation before myocardial revascularization: a Holter-electrocardiographic analysis
M J Van Dyck1, P L Baele, P Leclercq
1Department of Anesthesiology, Cliniques St-Luc, Catholic University of Louvain, Brussels, Belgium.
Insights
Preoperative autologous blood donation may increase silent myocardial ischemia and ventricular premature beats in patients undergoing coronary artery bypass grafting (CABG). Monitoring revealed more prolonged and intense silent ischemia post-donation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transfusion Medicine
Background:
- Preoperative autologous blood donation is common in cardiac surgery.
- Potential effects on myocardial ischemia and arrhythmias are not fully understood.
Purpose of the Study:
- To evaluate the influence of preoperative autologous blood donation on myocardial ischemia and arrhythmias in patients undergoing coronary artery bypass grafting (CABG).
Main Methods:
- 24-hour Holter monitoring before (day 1) and after (day 2) autologous blood donation in 24 CABG patients.
- Quantification of ischemic ST segment depression (duration and area) and classification of ventricular premature beats (VPBs) using the Lown grading system.
Main Results:
- Silent myocardial ischemia was significantly more prolonged and intense on day 2 post-donation.
- 40% of ischemic events were associated with the donation process or hospital travel.
- Increased severity of ventricular premature beats was observed in some patients.
Conclusions:
- Preoperative autologous blood donation may be associated with increased silent myocardial ischemia and arrhythmias in CABG patients.
- Further research is needed to identify patients at risk and optimize donation protocols.
Abstract:
The influence of preoperative autologous blood donation on myocardial ischemia and arrhythmias was evaluated in 24 patients scheduled for coronary artery bypass grafting (CABG). All had a Holter recorder placed 24 hours before predonation (day 1), the cassette was changed prior to donation, and the recording continued for 24 hours thereafter (day 2). Each patient served as his or her own control, and observations made on day 2 were compared with those of day 1. Ischemia was quantitated by calculating the duration (C.Dur.) and the area (C. Area) of ischemic ST segment depressions, and ventricular premature beats (VPB) were classified according to the Lown grading system. Twenty-one men and 3 women were monitored. On day 1, 9 patients had 20 ischemic events, 3 being symptomatic. Nine patients demonstrated ischemia on day 2, representing a total of 3 symptomatic and 26 silent events. When comparing the two monitoring periods, 7 patients had longer or more severe ST segment depression whereas 6 other patients presented with more severe VPBs on day 2. Three patients had less ischemia on day 2, one remained stable, and 13 had no ischemia throughout the study. Silent ischemia was significantly more prolonged (C.Dur.Sil 316 v 152 sec, P < 0.05) and more intense (C. Area Sil 8 v 3.8 mm.min, P < 0.05) on day 2. Moreover, on top of a normal circadian distribution of ischemic events in the morning and in the evening, 40% of events were related to the donation or to a trip to the hospital. No preoperative characteristic helped to detect patients at risk.(ABSTRACT TRUNCATED AT 250 WORDS)