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The Annals of Thoracic Surgery, Vol 52, 500-505, Copyright © 1991 by The Society of Thoracic Surgeons
E Ovrum, EA Holen, M Abdelnoor and R Oystese
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 (7/500, 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%).
ARTICLES
Conventional blood conservation techniques in 500 consecutive coronary artery bypass operations
Oslo Heart Center, Norway.
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