Multifaceted Blood Conservation Stratergy Reduces Periopertative Transfusion Requirement in Cardiac Surgery

Abstract

Fig. 1. Surgical progression of patient cohort. Discussion: Surgical outcomes of single ventricle palliation seem poor in patients with dextrocardia. Aggressive management of congenital AVVR could improve longterm prognosis (Fig. 1). http://dx.doi.org/10.1016/j.hlc.2013.03.053 2012 Poster Presentation/Panel 28 Multifaceted Blood Conservation Stratergy Reduces Periopertative Transfusion Requirement in Cardiac Surgery Benjamin M. Robinson1,4,∗, Waleed A. Ahmed1, William O’Regan2, Manish Jain1, Ajay Hirikannawar1, Hugh D. Wolfenden1, Bruce G. French1, Rebecca Dignan1,3 1Department of Cardiothoracic Surgery, Liverpool Hospital, Sydney, Australia 2 Department of Anaesthesia, Liverpool Hospital, Sydney, Australia A B S T R A C T S Heart, Lung and Circulation 481 2013;22:455–489 2012 ANZSCTS Annual Scientific Meeting 3 University of New South Wales Clinical School, Liverpool, Australia 4 The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia Introduction: This study aimed to evaluate the effect of a multifaceted blood conservation strategy on blood product transfusion rates in cardiac surgery. This strategy involved acute normovolaemic haemodilution, also known as autologous operative donation, low volume pump priming, retrograde autologous pump priming (RAPP) and theuse of the antifibrinolytic, tranexamic acid. Risk factors for transfusion were also evaluated. Methods: A retrospective analysis of 1582 consecutive cardiac surgery patients at Liverpool Hospital between January 2008 and June 2012 was performed. 473 patients made up the blood conservation group, commencing June 2011. Using propensity score methods, a matched cohort of historical controls was assembled. Multivariate logistic regression was used to determine the independence of risk factors for transfusion. Results:Themean age of patientswas 64.4. Themajority had coronary artery bypass grafting alone (63.1%) or single valve procedures (17.5%), while 39.6% of cases were non-elective. Increased age, prolonged cardiopulmonary bypass, elevated preoperative serum creatinine, previous cardiac surgery, low body surface area, urgent or emergency surgery and preoperative anti-platelet agent administration were independent risk factors for transfusion. The crude transfusion rates in theblood conservation groupand the remainder of the cohortwere 33.8% (95%CI; 29.5–38.1) and62.7% (95%CI; 59.9–65.6) respectively. There was a 27.4% (95% CI; 22.2–35.2) reduction in transfusion rate for the blood conservation cohort when compared to propensity score matched controls. Conclusions: A multifaceted blood conservation strategy combining antifibrinolytic use with changes in perfusion practice reduces perioperative blood product transfusion in cardiac surgery. http://dx.doi.org/10.1016/j.hlc.2013.03.054 2012 Poster Presentation/Panel 29 Management of the Empty Pleural Space with Balanced Chest Drainage to Prevent Post-Pneumonectomy Pul-