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Ann Thorac Surg 1994;57:1289-1294
© 1994 The Society of Thoracic Surgeons

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Articles

Shed blood autotransfusion influences ischemia-sensitive laboratory parameters after coronary operations

Departments of Cardiovascular Surgery and Clinical Chemistry, University of Freiburg, Freiburg, Germany

Accepted for publication September 21, 1993.

^_* Address reprint requests to Dr Fasol, Department of Cardiovascular Surgery. University of Freiburg, Hugstetterstrasse 55, D-79106 Freiburg iBr, Germany.

The diagnostic significance of ischemia-sensitive laboratory parameters in respect to possible interference with shed blood antotransfusion was assessed in a prospective study with 100 patients undergoing elective coronary artery bypass grafting. Serum levels of creatine kinase, crsatine Kinase MB activity, creatine kinase MB mass concenteation, 2-hydroxybulyrale dehydrogenase, lactate dehydnogenase-1, troponin-T, myoglobin, and glutamicoxaloacetic transaminase werw repeatedly assessed up to the sixth postoperative day. Thirty-seven patients were excluded from the study due to postoperative development of myocardial infarction (n = 4), transient ischemic eventa (n = 25), and left bundle-branch blocks (n = 8). In the ramaining group of 63, 37 patients were retransfused with 580 ± 370 mL shed blood up to the twelfth postoperative hour, and 26 patients did not receive autotransfusion due to minimal mediastinal blood loss, the results of our study show that the ischemia-sensitive laboratory parameters were significantly influenced by shed blood autotransfusion: 8 hours postoperatively, creatine kinase (272%), creatine kinase MB fraction (151%) 2-hydroxybutyrate dehydrogenase (130%), lactate dehydiogenase-1 (133%), troponin-T (200%), myoglobin (159%) and glutamic-oxaloacetic transaminase Ievels (153%) were significantly elevated (p < 0.05) in patients with posloperative autotransfusion, although there were no electrocardiographic signs of myocardial ischemia in this group of patients. Our study shows that postoperative autotransfusion of mediastinal shed blood may interfere with the diagnosis of perioperative myocardial ischemia by laboratory parameters in corunary bypass patients.

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