Cardiotomy Suction Versus Red Cell Spinning During Repair of Descending Thoracic Aortic Aneurysms

Abstract

Listen

Translate article

Two consecutive series of patients undergoing repair of descending thoracic and thoracoabdominal aortic aneurysms with partial cardiopulmonary bypass and low systemic heparinization (activated coagulation time: ACT> 180 sec) for proximal unloading and distal protection were analyzed. During the surgical procedures, thoracic shed blood was recovered either with a red cell spinning autotransfusion device (n=10) or two pump suckers and Duraflo II heparin surface coated cardiotomy reservoirs (n=10). There were 5/10 acute lesions and 1/l0 ruptures for the autotransfusion group versus 5/10 acute lesions and 2/10 ruptures for the cardiotomy group (NS). Extension of aortic resection (range 1-8) was 3.6±1.2 for autotransfusion versus 3.5±1.4 for cardiotomy suction (NS). Mean number of reimplanted patches for intercostal and visceral reperfusion was 0.3±0.6 for autotransfusion versus 0.6±1.0 for cardiotomy (NS). Perfusion time was 41±17 min for autotransfusion versus 60±19 min for cardiotomy (p<0.05) and cross clamp time was 33±14 min for autotransfusion versus 43±17 min for cardiotomy (p<0.01). Total heparin dose was for 9500±2100 IU for autotransfusion versus 9800±1300 IU for cardiotomy (NS). The mean of the lowest ACTs measured during perfusion was 281±121 sec for autotransfusion versus 258±58 sec for cardiotomy (NS). The total protamine dose given was 7800±2100 IU for autotransfusion versus 9700±1900 IU for cardiotomy (p<0.05). The volume of washed red cells prepared was 3186±1318 ml forautotransfusion versus 0 for cardiotomy (p<0.05). Homologous blood and blood products transfused accounted for 3556±2491 ml for autotransfusion versus 3202±1084 for cardiotomy (NS). Chest tube drainage (day 1) was 878±421 m1 for autotransfusion versus 690±520 ml for cardiotomy (NS). Survival (30 days) was 10/10 for autotrans versus 10/10 for cardiotomy (NS). Cardiotomy suction using heparin coated reservoirs for shed blood recovery during partial cardiopulmonary bypass with low systemic heparinization simplified repair of more complex descending thoracic aortic aneurysms and resulted in similar outcome.