| Blood Conservation
in Open-Heart Surgery: Avoiding Predonated Autologous Blood |
(Department of Cardiovascular Surgery, Yamanashi
Central Hospital, Yamanashi, Japan)
| Hiroshi Osawa |
Kouji Tsuchiya |
Hiroyuki Saito |
| Hiroshi Furukawa |
Youhei Kabuto |
Yoshinao Iida |
|
Background: Operative blood loss
during open-heart surgery has been decreasing recently. We have
stopped predonated autologous blood transfusions to reduce hospital
stay and cost. Material and methods: In 70 consecutive elective
open-heart cases, we used intraoperative hemodilutional autologous
transfusions and intraoperative autotransfusions to avoid homologous
blood transfusion. Predonated autologous blood transfusion was
not used. All patients received an infusion of high-dose tranexamic
acid prior to and after cardiopulmonary bypass (CPB). Results:
Homologous blood transfusion was not required in 77.1% of patients
who underwent open-heart surgery. When further classified, 84.5%
of patients who underwent primary open-heart surgery, 41.7% of
patients who underwent a reoperation, and 33.3% of patients who
were preoperatively anemic did not require homologous blood transfusion.
In patients who undergo reoperation and who are preoperatively
anemic, the rate of homologous blood transfusion is high. Therefore,
during the reoperation, intraoperative autologous blood transfusion
should be used before starting CPB, and iron should be given
to anemic patients prior to reoperation. Conclusion: Our strategy
of blood conservation consists of intraoperative hemodilutional
autologous transfusion, intraoperative autotransfusion, infusion
of high-dose tranexamic acid prior to and after CPB and, avoiding
predonated autologous blood transfusion. Based on our experience,
predonated autologous blood transfusion is usually unnecessary
for cases who undergo surgery for the first time and are not
anemic. Predonated autologous blood transfusion should be reserved
only for high risk patients with anemia and reoperation cases.
For further blood conservation, we need to study the safety limits
of non-transfusion in open-heart surgery.
Jpn. J. Cardiovasc. Surg. 29: 63-67 (2000) |
|
