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The Journal of Cardiovascular Surgery 2000 June;41(3):407-13

language: English

Intraoperative autotransfusion for repair of unruptured aneurysms of the infrarenal abdominal aorta. A multicenter study of 203 patients

Association Universitaire de Recherche en Chirurgie (AURC), Patra P. *, Chaillou P. *, Bizouarn P. **

From the *Service de Chirurgie Vasculaire
**Départment d’Anesthésie-Réanimation Hôpital Guillaume et René Laënnec, Nantes, France


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Background. The ­goals of ­this ­study ­were to eval­u­ate the ­costs and sav­ings of ­intra- and post­op­er­a­tive ­blood trans­fu­sions as ­well as the poten­tial bio­log­i­cal mod­ifi­ca­tions asso­ciat­ed ­with the use of intra­op­er­a­tive ­blood sal­vage.
Methods. Intraoperative auto­tran­fu­sion (­IOAT) ­with ­wash-out was pros­pec­tive­ly stud­ied dur­ing the ­repair of unrup­tured aneu­rysms of infra­ren­al abdom­i­nal aor­ta in 203 ­patients oper­at­ed on in 13 insti­tu­tions.
Results. The ­mean quan­tity of ­blood ­retrieved was 688±468 ml. The ­mean quan­tity of ­blood deriv­a­tives and intra­op­er­a­tive ­solutes ­used for reple­tion was 4261 ml, rang­ing ­from 1723 ml ­between ­days 0 to D2 to 562 ml ­from D3 to D8. Ninety-­eight ­patients did not ­receive any ­blood deriv­a­tives at all. Thirty-­five ­patients ­received plas­ma to cor­rect coag­u­la­tion fac­tors. The quan­tity of auto­trans­fused glob­u­lar con­cen­trate was ­less ­than 500 ml in 89 ­patients.
Conclusions. ­IOAT pre­clud­ed the ­need for trans­fu­sion of homol­o­gous glob­u­lar con­cen­trates, par­tic­u­lar­ly in ­those ­patients who had ­bled ­most. On aver­age, ­more ­than two glob­u­lar con­cen­trates ­were recu­per­at­ed. Use of ­IOAT led to finan­cial sav­ings. Perioperative bleed­ing is not the ­only fac­tor ­that inter­venes in the deci­sion to trans­fuse glob­u­lar con­cen­trates. Postoperative dilu­tion is the ­most impor­tant fac­tor as attest­ed by the ­amount of pro­tides and the hem­a­toc­rit. Coagulation fac­tors are mod­i­fied but ­remain com­pat­ible ­with nor­mal hemat­o­sis in 83% of ­patients under­go­ing oper­a­tion.

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