EReply. Is retrograde autologous priming effective on cerebral functions and haematocrit levels?

Abstract

We were pleased to receive Dr Gurbuz and colleagues' comments on our study [1]. Yet, we would like to add some comments to their remarks. Firstly, we can state that there were no differences between the study and the control group concerning the surgeons performing the procedure. We agree that the surgeon himself, often directly affects the amount of blood lost intraoperatively. However, in our hospital, the transfusion strategies are the result of a team approach and they are the same for each patient, regardless of the team members present in the operating theatre. Secondly, as the effect of retrograde autologous priming (RAP) on haemodilution and transfusion requirements was the main endpoint of our study, the effect of this technique on neurological complications were not reported. As referred in our article, lower intraoperative haematocrit levels can result in postoperative end-organ dysfunction, as shown by several large observational studies [2], including both transient and permanent stroke. As RAP increases the intraoperative haematocrit, one could suggest that this technique should improve the preservation of multiple organs. However, we did not look into the direct effect of RAP on these outcome variables and we think this should be the subject of further investigation. Finally, we agree with Dr Gurbuz that the phosphorylcholine coating has been proven to protect the platelets [3] during cardiopulmonary bypass (CPB) and affects blood loss and hematocrit levels. We want to emphasize that, besides the cannulas, all CPB circuits used in our study were completely phosphorylcholine-coated. Indeed, there was no difference between the haematocrit of both groups on admission to the ICU, which means that in the RAP group, the same haematocrit was achieved with less transfusion compared to the control group. In conclusion, we would like to thank Dr Gurbuz and his colleagues for their constructive remarks and hopefully, together we can further improve blood management strategies in the future. Conflict of interest: none declared.