| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1998;65:125-136
© 1998 The Society of Thoracic Surgeons
Departments of Cardiothoracic Surgery and Anesthesiology, The New York Hospital–Cornell Medical Center, New York, New York, USA
Department of Cardiothoracic Surgery, Albert Einstein College of Medicine, New York, New York, USA
Accepted for publication July 10, 1997.
Dr Rosengart, Department of Cardiothoracic Surgery, Cornell University Medical College, 525 E 68th St, New York, NY 10021.
Background. Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open heart surgical procedures. We hypothesized that a comprehensive multimodality blood conservation program applied algorithmically on the basis of bleeding and transfusion risk would provide a maximum, cost-effective, and safe reduction in postoperative bleeding and allogeneic blood transfusion.
Methods. One hundred consecutive patients undergoing coronary artery bypass grafting were prospectively enrolled in a risk factor–based multimodality blood conservation program (MMD group). To evaluate the relative efficacy and safety of this comprehensive approach, comparison was made with a similar group of 90 patients undergoing coronary artery bypass grafting to whom the multimodality blood conservation program was not applied but in whom an identical set of transfusion guidelines was enforced (control group). To evaluate the cost effectiveness of the multimodality program, comparison was also made between patients in the MMD group and a consecutive series of contemporaneous, diagnostic-related group–matched patients.
Results. One hundred consecutive patients in the MMD group underwent coronary artery bypass grafting without allogeneic transfusion. This compared favorably with the control population in whom a mean of 2.2 ± 6.7 units of allogeneic blood was transfused per patient (34 patients [38%] received transfusion). In addition, the volume of postoperative blood loss at 12 hours in the control group was almost double that of the MMD group (660 ± 270 mL versus 370 ± 180 mL [p < 0.001]). Total costs for the MMD group in each of the three major diagnostic-related groups were equivalent to or significantly less than those in the consecutive series of diagnostic-related group–matched patients.
Conclusions. Comprehensive risk factor–based application of multiple blood conservation measures in an optimized, integrated, and algorithmic manner can significantly decrease bleeding and need of allogeneic transfusion in coronary artery bypass grafting in a safe and cost-effective manner.
This article has been cited by other articles:
|
|
 |
|
  K. A. Samolyk State-of-the-Art Blood Management in Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2009; 13(2): 118 - 121. [Abstract] [PDF]
|
|
|
|
 |
|
 L. Y. Lee, W. J. DeBois, K. H. Krieger, and O. W. Isom Transfusion Therapy and Blood Conservation Card. Surg. Adult, January 1, 2008; 3(2008): 415 - 430. [Full Text]
|
|
|
|
|
|
F. E. Ralley Programmatic Blood Conservation in Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 242 - 246. [Abstract] [PDF]
|
|
|
|
|
|
C. McKay Perfusion Approaches to Blood Conservation Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 252 - 255. [Abstract] [PDF]
|
|
|
|
 |
|
 D. Jaspan Erythropoietic therapy: Cost efficiency and reimbursement Am. J. Health Syst. Pharm., August 15, 2007; 64(16_Supplement_11): S19 - S29. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. O'Flynn, S. Purkayastha, T. Athanasiou, and R. Casula Repair of a Giant Left Ventricular Pseudoaneurysm in a Jehovah's Witness. Asian Cardiovasc Thorac Ann, August 1, 2006; 14(4): 328 - 330. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Engles Review and application of serine protease inhibition in coronary artery bypass graft surgery Am. J. Health Syst. Pharm., September 15, 2005; 62(18_Supplement_4): S9 - S14. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Dial, E. Delabays, M. Albert, A. Gonzalez, J. Camarda, A. Law, and D. Menzies Hemodilution and surgical hemostasis contribute significantly to transfusion requirements in patients undergoing coronary artery bypass J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 654 - 654. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Shander, D. Moskowitz, and T. S. Rijhwani The Safety and Efficacy of "Bloodless" Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 53 - 63. [Abstract] [PDF]
|
|
|
|
|
|
L. T. Goodnough and A. Shander INVITED COMMENTARY Ann. Thorac. Surg., November 1, 2004; 78(5): 1554 - 1555. [Full Text] [PDF]
|
|
|
|
|
|
R. L. Holt, T. D. Martin, P. J. Hess, T. M. Beaver, and C. T. Klodell Jehovah's witnesses requiring complex urgent cardiothoracic surgery Ann. Thorac. Surg., August 1, 2004; 78(2): 695 - 697. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Murphy, S. M. Allen, J. Unsworth-White, C. T. Lewis, and M. J. R. Dalrymple-Hay Safety and efficacy of perioperative cell salvage and autotransfusion after coronary artery bypass grafting: a randomized trial Ann. Thorac. Surg., May 1, 2004; 77(5): 1553 - 1559. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. K. Banbury, J. A. White, E. H. Blackstone, and D. M. Cosgrove III Vacuum-assisted venous return reduces blood usage J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 680 - 687. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Karski and J. T. Balatbat Blood Conservation Strategies in Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2003; 7(2): 175 - 188. [Abstract] [PDF]
|
|
|
|
|
|
L. Y. Lee, W. J. DeBois, K. H. Krieger, and O. W. Isom Transfusion Therapy and Blood Conservation Card. Surg. Adult, January 1, 2003; 2(2003): 389 - 400. [Full Text]
|
|
|
|
|
|
B. Collier, J. Kolff, R. Devineni, and L. S. Gonzalez III Prophylactic positive end-expiratory pressure and reduction of postoperative blood loss in open-heart surgery Ann. Thorac. Surg., October 1, 2002; 74(4): 1191 - 1194. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Vuylsteke, C. Gerrard, M. H Cross, C. M Munsch, D. R Norfolk, V. Zamvar, N. Payne, I. Cavill, G. Caspari, W. H Gerlich, et al. Reducing blood transfusion BMJ, September 21, 2002; 325(7365): 655 - 655. [Full Text] [PDF]
|
|
|
|
 |
|
 K McCusker, V Vijay, W DeBois, R Helm, and D Sisto MAST system: a new condensed cardiopulmonary bypass circuit for adult cardiac surgery Perfusion, December 1, 2001; 16(6): 447 - 452. [Abstract] [PDF]
|
|
|
|
|
|
K. Kottke-Marchant and S. Sapatnekar Hemostatic Abnormalities in Cardiopulmonary Bypass: Pathophysiologic and Transfusion Considerations Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 187 - 206. [Abstract] [PDF]
|
|
|
|
|
|
J. Martin, D. Robitaille, L. P. Perrault, M. Pellerin, P. Page, N. Searle, R. Cartier, Y. Hebert, L. C. Pelletier, H. T. Thaler, et al. Reinfusion of mediastinal blood after heart surgery J. Thorac. Cardiovasc. Surg., September 1, 2000; 120(3): 499 - 504. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. D. Nader, W. Z. Khadra, N. T. Reich, D. R. Bacon, T. A. Salerno, and A. L. Panos Blood product use in cardiac revascularization: comparison of on- and off-pump techniques Ann. Thorac. Surg., November 1, 1999; 68(5): 1640 - 1643. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Savarese, H. Waitkus, F. M. Stewart, and M. Callery Bloodless Medicine and Surgery J Intensive Care Med, January 1, 1999; 14(1): 20 - 33. [PDF]
|
|
|
|
|
|
W. J. DeBois and T. K. Rosengart Retrograde autologous priming reduces blood use Ann. Thorac. Surg., September 1, 1998; 66(3): 987 - 987. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
