Mitral Valve Correction Without Usage of Donor Blood

Abstract

Objective: To study features of mitral valve replacement (MVR) without use of donor blood or its components. Methods: 489 patients (pts) with isolated mitral valve disease were operated during the period from 01/01/2000 till 01/01/2014. All operations were carried out without using donor blood or its components during treatment, and while cardiopulmonary bypass (CPB) haemoconcentrated columns, or cell-savers were not applied. There were 214 males and 275 females. In 372 (76.1%) pts, 468.7 ± 51.4 ml of blood on citrate was taken before the cross-clamping. Diuresis was stimulated on the beginning of operation by 80 mg furosemide and 100 ml mannite. Patient was completed by 6% refortane in a 250-300 ml dose before starting CPB, and the water balance on this stage was in the ranges + 284.4±39.6 ml. Retrograde autological priming (RAP) occurred in 81 (16.6%) pts in doses 588.5±71.2ml. By the time of the end of perfusion, the water balance did not exceed ranges of 700-900.0 ml. After a stop of CPB, its maximum contents were returned into patient, including full evacuation of the CPB`s reservoir. Average time of cross-clamping was 53.4±7.2 min, bloodless – 242.2±34.8 ml. Results: Hospital mortality (HM) among 489 pts was 1.0 % (5 pts died). Duration of stay on artificial lung ventilation was 5.5 ± 0.8 hours, in intensive care unit – 59.5 ± 7.5 hours, average time of the postoperative period was 9.1 ± 0.7 days. At discharge, moderate anemia (reduction of hemoglobin from 145 ± 9.8 g/L to 105 ± 14.3 g/L from initial) was marked. Conclusions: We recommend our method of MVR without use of donor blood and its components. Exceptions for it are significant anemia (hemoglobin less than 120), weight of patients less than 65 kg, arterial hypertension with hypertrophic left ventricle.