CONSISTENT NONPHARMACOLOGICAL BLOOD CONSERVATION IN PRIMARY AND REOPERATIVE CORONARY-ARTERY BYPASS-GRAFTING

Because much interest has been focused on blood conservation using dif ferent drugs and complicated blood cell processing devices, we analyze d our results with the use of a non-pharmacologic, simple and inexpens ive program for blood salvage in 2326 patients undergoing myocardial r evascularization. The material was divided into two groups: patients u ndergoing a primary coronary bypass operation (Group P, n=2298) and a smaller subset of patients undergoing repeat coronary bypass operation (Group R, n=28). At least one internal mammary artery was grafted in 99% of the patients, with supplemental saphenous vein grafts. Intraope ratively, autologous heparinized blood was removed before bypass and r etransfused at the conclusion of extracorporeal circulation. The volum e remaining in the extracorporeal circuit was returned without cell pr ocessing or hemofiltration. Autotransfusion of the shed mediastinal bl ood was continued hourly up to 18 h after surgery in all patients. The mean postoperative mediastinal drainage in group R was 543+/-218 ml, compared to 703+/-340 ml in Group P (P=0.01). In Group R, 1 patient (3 .6%) received packed red cells and no patients were given other homolo gous blood products, compared to 33 patients (1.4%) given red cells an d 35 patients (1.5%) given plasma transfusion in Group P (NS). Thus, i n total, 2257 patients (97.0%) were not exposed to any homologous bloo d products during hospitalization. Total hemoglobin loss was significa ntly higher in Group R, resulting in a mean hemoglobin concentration a t discharge of 109 +/- 13 g/l, compared to 121 +/- 14 g/l in Group P ( P=0.0002). Postoperative complications were few and the total in-hospi tal death rate was 0.5%. In conclusion, a simple conventional blood sa lvage protocol seems to be at least as effective as pharmacologic agen ts or complicated devices to reduce blood loss after primary and redo coronary bypass grafting.