Abstract
To compare an impact of retransfusion of blood processed in cell-saver (CS) with that of cardiopulmonary bypass (CPB) on blood coagulation in patients undergoing cardiac surgery. Prospective observational study using thromboelastography (TEG). TEG samples from 170 patients were analyzed. Cardiopulmonary bypass was used in 100 patients while 70 patients were operated off-pump. In 20 off-pump patients collected blood was processed by cell-saver and returned. In all patients clot formation after heparin neutralization by protamine was unimpaired. However, there was a significant increase in fibrinolysis defined by the TEG parameter Lysis time 30 min after the maximum amplitude of the clot was reached (Ly30) in groups with CPB or CS but this increase still did not exceed the threshold for clinical fibrinolysis (Ly30 > 7.5%). In the group without CPB there was no significant impact on coagulation. Surgery that avoids CPB and/or CS is the gentlest method for inducing blood coagulation.
Highlights
Cardiac surgical procedures are complex, usually longlasting and performed most frequently in seniors suffering from concomitant diseases and taking various medications
The majority of procedures are accomplished on cardiopulmonary bypass (CPB) but some can be performed without CPB on the beating heart
It can be seen that cardiopulmonary bypass accelerates coagulation according to shortened values of reaction and clotting times (R and K), does not affect the clot strength and activates fibrinolysis
Summary
Cardiac surgical procedures are complex, usually longlasting and performed most frequently in seniors suffering from concomitant diseases and taking various medications. To reduce the burden associated with blood transfusions - transfusion-associated immunomodulation, lung injury or circulatory overload to name just a few - resulting in decreasing patients’ survival with increasing number of transfusions[1] the shed blood in pump procedures is often retransfused directly back to the patient or in offpump procedures it is collected to a cell-saver, processed and returned back to the patient. In both cases, the blood is in contact with a serose lining in the pericardium and/or in pleural cavities, sometimes for a long time. It has been shown that blood contact with the pericardial cavity induces strong hemolysis, inflammatory mediator release, and coagulation activation, driven by tissue factor pathway activation[2]
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