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James W. Jones
Robert E. Rawitscher
Thomas R. McLean
Arthur C. Beall
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Ann Thorac Surg 1991;51:541-544
© 1991 The Society of Thoracic Surgeons

Articles

Benefit from combining blood conservation measures in cardiac operations

James W. Jones, MD, PhD*,a,b, Robert E. Rawitscher, MDa,b, Thomas R. McLean, MDa,b, Arthur C. Beall, Jr, MDa,b, John I. Thornby, PhDa,b

a The Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, Texas USA
b The Ritter Heart Institute, Toledo, Ohio USA

* Address reprint requests to Dr Jones, Surgical Service, 2002 Holcombe Blvd, Houston, TX 77030.

Conventional blood conservation techniques have been insufficient to decrease transfusion needs in increasingly complex cardiac operations. To evaluate combinations of conservation techniques, 300 patients were divided into three equal groups. Group 1 had intraoperative autotransfusion and return of mediastinal drainage for 4 hours postoperatively. Group 2 had these measures plus intraoperative plasmapheresis. These two groups were given a transfusion for a hematocrit of less than 0.21 on Cardiopulmonary bypass. Group 3 was treated with the same measures as group 2 but did not receive transfusions while on pump unless the hematocrit decreased to less than 0.15. The percentage of patients in each group given transfusions in the operating room was 34% in group 1, 28% in group 2, and 7% in group 3 (p < 0.05). The percentage of all patients receiving transfusions during hospitaliization was 68% in group 1, 36% in group 2 (p < 0.05), and 18% in group 3 (p < 0.05). Average total units transfused were 2.16 ± 0.25 in group 1, 0.7 ± 0.15 in group 2 (p < 0.05), and 0.37 ± 0.07 in group 3 (p < 0.05). The perioperative morbidity rates including myocardial infarctions and strokes were similar. There were no deaths in group 3. Combining complementary conservation measures is effective in reducing homologous blood transfusions, and the need for transfusion can be safely reduced by allowing profound hemodilution during bypass.




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