Intraoperative Autologous Transfusion during Elective Infrarenal Aortic Reconstruction

Abstract

Intraoperative autologous transfusion devices have been purported to reduce allogenic transfusions and their associated complications. However, the value of their routine use during elective cardiovascular operations remains undefined. This study was designed to examine the efficacy of the Haemonetics Cell Saver (CS) during elective aortic reconstructions and identify predictors of clinically significant (≥500 cc) and cost-efficient (≥1250 cc) salvage volumes. The medical records of all patients undergoing elective infrarenal aortic reconstructions between January 1991 and June 1995 were retrospectively reviewed to determine blood loss, CS return, predictors of clinically significant/cost-efficient CS returns, blood products transfused, and estimated cost per unit CS return. The CS was used for 138 (82.1%) of all reconstructions during the study period. Estimated blood loss (2127 ± 1467 vs 1415 ± 1047) and CS return (927 ± 790 vs 515 ± 408) were significantly greater in patients with aneurysms (AAA,N= 63) compared to those with aortoiliac occlusive disease (AIOD,N= 75). CS returns ≥500 cc were common (79.4% AAA, 52.0% AIOD) and predictors of ≥500 cc CS returns were large aneurysms (6.79 ± 1.84 vs 5.72 ± 0.71 cm) and male sex (82.0 vs 46.2%) in AAA patients and lower preoperative platelet counts (262 ± 93 vs 311 ± 113 K/mm3), concomitant renal revascularizations (20.5 vs 0%), and prolonged operative time (7.9 ± 2.4 vs 6.9 ± 2.1 hr) in AIOD patients. In contrast, CS returns ≥1250 cc were relatively uncommon (28.6% AAA, 5.3% AIOD), and predictors of these CS returns were found only for AAA patients and included any concomitant vascular procedures (38.8 vs 15.6%) and the need for suprarenal aortic clamping (27.8 vs 6.7%). Despite the use of the CS, 73.8% of all patients required allogenic packed red blood cells with a mean of 3.0 ± 3.1 units transfused in the perioperative period; no difference was seen between AAA and AIOD patients. The calculated cost for a unit of CS return was $128.77 for the AAA patients and $231.91 for the AIOD patients. Not using the CS and substituting the return with allogenic packed red blood cells would have saved $252.80 and $352.84 for the AAA and AIOD patients, respectively. Routine use of the CS during elective infrarenal aortic reconstructions is not cost efficient and should be abandoned. Use of the device should be reserved only for complex reconstruction.