Effect of Retrograde Autologous Priming in Adult Cardiac Surgery for Minimizing Hemodilution and Transfusion Requirements

Kim, Kyung Hwan

Abstract

BACKGROUND: Hemodilution after priming of the cardiopulmonary bypass is known to increase the possibility of bleeding and homologous transfusion in adult cardiac surgery. We investigated the effects of retrograde autologous priming (RAP) to see whether it would decrease postoperative bleeding and homologous transfusion. MATERIAL AND METHOD: We retrospectively reviewed 34 patients wpho underwent RAP and 46 patients who did not. Retrograde autologous priming consisted of arterial line drainage, venous reservoir and oxygenator drainage and venous line drainage. We compared the amount of priming solution and RAP volume, perioperative hematocrit, postoperative bleeding and transfusion requirements in the two groups. RESULT: Mean withdrawal volume in RAP group was 613.5+/-160.6 mL and initial priming volume was 1381.9+/-37.2 mL. Hemoatocrits (%) in RAP and control groups were 25.0+/-3.7 vs 20.9+/-3.6 (5 minutes after CPB), 25.9+/-3.7 vs 22.5+/-3.6 (30 minutes after CPB), 25.9+/-3.4 vs 23.8+/-2.8 (60 minutes after CPB), 31.9+/-3.9 vs 31.5+/-4.5 (postoperative 1 hour), 32.4+/-4.4 vs 32.1+/-4.5 (postoperative 6 hours), 33.4+/-5.0 vs 31.7+/-5.1 (postoperative 1 day)[repeated measures ANOVA, p<0.05]. Chest tube drainages (mL) in the two groups were 357.2+/-177.1 vs 411.7+/-279.5 (postoperative 6 hours), 599.4+/-145.6 vs 678.8+/-256.4 (postoperative 24 hours)[t-test, p<0.05]. Homologous transfusion was performed in 7 out of 34 patients in RAP group (20.6%), and 16 out of 46 (34.8%) in control group (p<0.05).
CONCLUSION
This study suggests that the effects of reducing the priming volume during cardiopulmonary bypass may result in lesser bleeding and homologous transfusion. Retrograde autologous priming would be used to reduce postoperative bleeding and chance of transfusion after adult cardiac surgery.