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The Journal of Cardiovascular Surgery 2022 December;63(6):700-7

DOI: 10.23736/S0021-9509.22.12415-8

Copyright © 2022 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC 4.0 license which allows users to distribute, remix, adapt and build upon the manuscript, as long as this is not done for commercial purposes, the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI), provides a link to the license and indicates if changes were made.

lingua: Inglese

Novel method for direct retransfusion reduces blood transfusions in descending and thoracoabdominal aneurysm repair

Lizette KARLSSON 1, Ali BABAIE-KHOJINI 1, Linus BLOHMÉ 2, Alireza DARYAPEYMA 2, 3, Anders GÜNTHER 1, 3, Lena NILSSON 1, Carl-Magnus WAHLGREN 2, 3, Anders FRANCO-CERECEDA 3, 4, Christian OLSSON 3, 4

1 Department of Cardiothoracic Anesthesia, Karolinska University Hospital, Stockholm, Sweden; 2 Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden; 3 Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden; 4 Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden

BACKGROUND: Allogenic blood product usage is associated with worse outcomes in open repair of descending and thoracoabdominal aortic aneurysms. This pilot study evaluated the safety and efficacy of a novel modification of the left heart bypass (LHB) circuit to reduce intraoperative blood transfusions.
METHODS: In modified LHB, pump suckers collected shed blood that was directly retransfused through a femoral vein cannula. In standard LHB, cellsavers were used to collect, wash, and retransfuse shed blood. Consecutive patients undergoing elective surgical descending or thoracoabdominal aneurysm repair using modified (N.=12) or standard (N.=21) LHB were compared. Intraoperative blood product use was the primary outcome. Hypotensive episodes, lactate levels, and adverse events (early mortality, spinal cord injury, renal and respiratory insufficiency) were secondary outcomes.
RESULTS: Groups were comparable regarding pre- and intraoperative variables. No perfusion-related adverse events occurred. With modified LHB, intraoperative blood product use was significantly reduced: packed red blood cells by 60% from 10 to 4 units (P=0.002), fresh frozen plasma by 70% from 17 to 5 units (P<0.001) as well as retransfused cellsaver volume by 75%, from 4500 mL to 1110 mL (P<0.001). Hemodynamic instability occurred in 1 (8.3%) vs. 6 (29%), P=0.22 and overall lactate levels were significantly reduced (P=0.045) with modified LHB. Adverse events combined occurred in 1/12 vs. (P=0.022).
CONCLUSIONS: The novel modified LHB with direct retransfusion was safe and associated with significantly reduced intraoperative blood product use, reduced lactate production and improved clinical outcomes as compared to standard LHB and could represent an important clinical improvement.

KEY WORDS: Aortic aneurysm, thoracic; Blood transfusion; Cardiopulmonary bypass

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