019 * BLOOD CONSERVATION STRATEGIES IN CARDIAC SURGERY: MORE IS BETTER

Abstract

Objectives: Recent data show that up to 50% of heart procedures require blood transfusion, which can have adverse long- and short-term outcomes for the patient. This led to the updated 2011 STS/SCA guidelines in an attempt to adopt more effective blood conservation techniques. We present our results after the implementation of a more aggressive strategy for intraoperative blood conservation in cardiac surgery. Methods: Our cardiac surgery database was reviewed retrospectively, comparing outcomes from two different time periods, after the implementation of a more effective two-fold blood conservation strategy beginning in March 2012: more aggressive intraoperative autologous donation (IAD) based on a newly constructed nomogram, and the use of a shorter length circuit of the cardiopulmonary bypass (CPB) which allowed for lower fluid volume as a prime. The method of retrograde autologous priming (RAP) was the same for both time periods. Results: A total of 1126 patients (group 1) were studied in a 12-month period (March 2012-February 2013) after the implementation of the new strategy, and compared to 2758 patients (group 2) from the previous 36-month period (March 2009-February 2012). There was a significant reduction in the percentage change of the intraoperative haematocrit between groups 1 and 2 (14% vs 28%, P = 0.01), with an increase in the mean IAD volume (655 ml vs 390 ml, P = 0.02) and a reduction in the CPB prime volume (1000 ml vs 1600 ml, P = 0.03). Group 1 required significantly fewer blood transfusions in the perioperative period (29% vs 49%, P = 0.02) and had significantly reduced postoperative rates of respiratory failure (3% vs 7%, P = 0.03), pneumonia (1% vs 3.1%, P = 0.01), chest tube output (350 ml vs 730 ml, P = 0.01), reoperation for bleeding (1.2% vs 2.5%, P = 0.04), and length of stay (6.1 days vs 8.2 days, P = 0.05). Conclusions: Aggressive IAD and low CPB prime, along with effective RAP, is the three-fold blood conservation strategy that leads to improved outcomes in cardiac surgery.