Should the Cell Saver Autotransfusion Device be used routinely in all infrarenal abdominal aortic bypass operations?

The purpose of this study was to attempt to identify a group of patients undergoing infrarenal aortic bypass in whom blood loss is consistently less than 2 units, making the routine use of autotransfusion devices unnecessary.

Four groups of patients were prospectively studied as follows: abdominal aortic aneurysm (AAA) repair with tube graft (n = 21), AAA repair with bifemoral or biiliac bypass (n = 19), and aortobifemoral bypass (AFB) or biiliac bypass for occlusive disease either with Cell Saver Autotransfusion Device (Haemonetics Corp., Braintree, Mass.) (n = 18) or without Cell Saver (n = 18). The latter two groups were randomized on an alternating basis.

The following parameters were obtained on all patients: preoperative hemoglobin values, estimated blood loss, Cell Saver return volumes, intraoperative and postoperative homologous blood transfused, postoperative hemoglobin values on the day of surgery and on postoperative days 1 and 4, complications, and length of hospital stay. In comparing the groups undergoing AFB with Cell Saver and AFB without Cell Saver by the above parameters, we found no statistically significant differences, except for a higher hemoglobin level on postoperative day 1 in the group undergoing AFB with Cell Saver (mean 11.86 vs 10.74, p = 0.02). The estimated blood loss and Cell Saver return volumes were less for those patients undergoing AFB for occlusive disease compared with those undergoing AFB for aneurysmal disease. Interestingly, estimated blood loss and Cell Saver return volumes for patients with AAA with tube graft and patients undergoing AFB with Cell Saver were similar.

We conclude that routine setup and use of rapid autotransfusion devices may not be necessary in every patient undergoing routine aortofemoral bypass for occlusive disease. Furthermore, the possibility that some patients may undergo AAA repair with tube grafts without use of the Cell Saver may be deserving of further investigation.