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Reduction of Homologous Transfusions in Open-Heart Surgery

Department of Cardiothoracic Surgery, Internal Medicine, and Infectious Diseases, "L. Sacco Hospital," Milan, Italy

Daniele G. Di Mattia, M.D.

Department of Cardiothoracic Surgery, Internal Medicine, and Infectious Diseases, "L. Sacco Hospital," Milan, Italy

Piero Castelli, M.D.

Department of Cardiothoracic Surgery, Internal Medicine, and Infectious Diseases, "L. Sacco Hospital," Milan, Italy

Annamaria Condemi, M.D.

Department of Cardiothoracic Surgery, Internal Medicine, and Infectious Diseases, "L. Sacco Hospital," Milan, Italy

Stefano Guzzetti, M.D.

Department of Cardiothoracic Surgery, Internal Medicine, and Infectious Diseases, "L. Sacco Hospital," Milan, Italy

Paola Meraviglia, M.D.

Department of Cardiothoracic Surgery, Internal Medicine, and Infectious Diseases, "L. Sacco Hospital," Milan, Italy

Carmine Santoli, M.D.

Department of Cardiothoracic Surgery, Internal Medicine, and Infectious Diseases, "L. Sacco Hospital," Milan, Italy

Use of homologous blood is relatively frequent in cardiac surgery and represents a potential risk for sensitivity or infective contamination.

A prospective study on 744 patients (operated on before September, 1986, and considered as the control group) revealed that the incidence of posttransfusion hepatitis was 12.7% (mean overall blood loss was 1270±115 mL; bank-blood-transfused patients comprised 91.9% of the group; and bank-blood-transfused units averaged 8.6/patient).

From September, 1986, to December, 1990, 924 patients underwent elective open-heart operations. Autotransfusion only was used in group A (400 patients). Aprotinin was added to autotransfusion in group B (192 patients). Aprotinin only was used in group C (332 patients). The bank blood requirement was reduced drastically in all groups. In group A, mean blood loss was 870±85 mL, and transfusions were required in 29.7% of patients with a mean bank blood unit/patient of 2.6 ± 1.8. In group B, mean blood loss was 425 ± 55 mL, and transfusions were required in 11.5% of patients, with a mean bank blood unit/patient of 1.8 ± 1.3. In group C, mean blood loss was 405 ± 45 mL, 31.9% of patients had bank blood transfusion, and mean bank blood unit/patient was 2.1±1.2.

The incidence of posttransfusion hepatitis was 4.2% in group A, whereas no infective complications were found in the other groups.

The basal mean hematocrit value in groups A and B was 42.1±2.7% and 41.4±2.0%, respectively, and preoperatively, after a blood withdrawal of 3 units, was, respectively, 34.8±1.9% and 33.8±1.1%. In group C the mean preoperative hematocrit value was 41.7 ±2.2%. Mean hematocrit values at discharge were similar in all three groups, ranging around 30%.

Platelet count dropped in group A after surgery (-41%) and increased in the postoperative period, never reaching the basal value. Patients receiving aprotinin (groups B and C) presented a lower postoperative platelet decrease (respectively -28.6% and - 26.1 %), with a discharge value lower than basal.

Autologous blood collection and aprotinin administration proved to be a well-tolerated and uncomplicated method. This represented the most important and effective blood-saving procedure in cardiac surgery, minimizing the bank blood requirement and minimizing or even eliminating posttransfusion complications.

Vascular and Endovascular Surgery, Vol. 26, No. 9, 693-699 (1992)
DOI: 10.1177/153857449202600901


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