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Ann Thorac Surg 1991;52:500-505
© 1991 The Society of Thoracic Surgeons

Articles

Conventional blood conservation techniques in 500 consecutive coronary artery bypass operations

Eivind Øvrum, MD*, Einfrid Åm Holen, MD, Michel Abdelnoor, PhD, Rolf Øystese, CP

Oslo Heart Center, Oslo, Norway

Accepted for publication April 24, 1991.

* Address reprint requests to Dr Øvrum, Oslo Heart Center, Pilestredet 32, 0027 Oslo 1, Norway.

With use of a nonpharmacological, simple, and inexpensive program for blood conservation, 500 consecutive patients underwent elective coronary artery bypass grafting without need of homologous red cell transfusions in 493 (98.6%). At least one internal mammary artery was grafted in all but 1 patient, with supplemental saphenous vein grafts. Intraoperatively, autologous heparinized blood was removed before bypass and retransfused at the conclusion of extracorporeal circulation. The volume remaining in the oxygenator and tubing set was returned without cell processing or hemofiltration. Using the hard-shell cardiotomy reservoir from the heart-lung machine, autotransfusion of the shed mediastinal blood was continued hourly up to 18 hours after operation. The mean postoperative mediastinal blood loss was 643 ± 354 mL, whereas 624 ± 296 mL was autotransfused. Thirteen patients (2.6%) needed reexploration for bleeding, of whom 7 ( [equation], 1.4%) received homologous blood. No other patients required red cell transfusions. In addition, 9 patients were given a mean of 2.6 units of fresh frozen plasma because of suspected coagulopathy. No platelets were transfused, and no cryoprecipitate therapy was undertaken. Thus, in total, 484 patients (96.8%) were not exposed to any homologous blood products during the hospital stay. At discharge, the mean hemoglobin concentration was 121 ± 14 g/L (12.1 ± 1.4 g/dL) and the hematocrit, 0.36 ± 0.04. Postoperative complications were few. There was one in-hospital death (0.2%).




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