Cell Saver Blood Transfusion Research Articles

Gigantic 25-cm abdominal aortic aneurysm

A 69-year-old man presented to the hospital in June 1993 with a prominent, visibly pulsatile abdominal mass (A). The patient had a history of smoking, hypertension, hepatitis C, and tuberculosis and had noted a pulsation in his abdomen for several years but had never sought medical attention. Physical examination demonstrated a very large, nontender, pulsatile mass with a soft bruit. Translumbar aortography revealed a gigantic infrarenal abdominal aortic aneurysm (AAA) measuring 25 cm in diameter with a large mural thrombus extending to the aortic bifurcation and both common iliac arteries (B). The patient was prepared for urgent open surgical aneurysm repair under general anesthesia and gave informed consent for photographic documentation and publication of his case. At operation (C), the aneurysm was readily exposed; the transverse diameter was measured with a centimeter scale and recorded as 25 cm by the surgeon. After infrarenal cross-clamping, the aneurysm was opened, a massive mural thrombus was removed, and a bifurcated 22 10-cm knitted Dacron aortoiliac graft was sewn in place (D). Excess aneurysm wall was trimmed, and the remaining aneurysm wall was closed over the graft. The patient received one unit of Cell Saver blood transfusion, was extubated immediately after the operation, and had an uneventful recovery. He was discharged from the hospital on day 12 and had no subsequent events related to the aneurysm or surgical repair. He survived for 7 years, dying of heart failure at the age of 76 years. The majority of AAAs are discovered when they are 6 cm, with an annual rupture risk of 30% to 50% for aneurysms >8 cm. Thus, it is unlikely that patients with very large aneurysms survive for a long time. Indeed, aneurysms >10 cm are rare, with only a few reports of successful repair of giant aneurysms larger than 12 cm. The largest reported diameter in published cases of giant unruptured AAA is 15 cm. This report of a 25-cm gigantic AAA may represent the largest successfully repaired infrarenal AAA in the world’s literature.

Tricuspid Valve Repair for the Poor Right Ventricle: Tricuspid Valve Repair in Patients with Mild-to-Moderate Tricuspid Regurgitation Undergoing Mitral Valve Repair Improves In-Hospital Outcome.

Background Tricuspid regurgitation (TR) in patients undergoing surgery for mitral valve (MV) increases morbidity and mortality, especially in case of a poor right ventricle. Does repair of mild-to-moderate insufficiency of the tricuspid valve (TV) in patients undergoing MV surgery lead to a benefit in early postoperative outcome? Methods A total of 22 patients with mild-to-moderate TR underwent MV repair and concomitant TV repair with Tri-Ad (Medtronic ATS Medical Inc., Minneapolis, Minnesota, United States) and Edwards Cosgrove (Edwards Lifesciences Irvine, California, United States) rings. The severity of TR was assessed echocardiographically by using color-Doppler flow images. The tricuspid annular plane systolic excursion (TAPSE) was under 1.7 cm. Additional procedures included coronary artery bypass (n = 9) and maze procedure (n = 15). The following parameters were compared: postoperative and peak dose of noradrenaline (NA), pre/postoperative systolic pulmonary pressure (sPAP), extubation time, operation time, cross-clamp time, cardiopulmonary bypass (CPB) time, pre/postoperative ejection fraction (EF), intensive care unit (ICU)-stay, hospital stay, cell saver blood transfusion, intra/postoperative blood transfusion, and postoperative TR. Results The mean age was 67 ± 14.8 years, 45% were male. Mean EF was 47 ± 16.2%, postoperative 52 ± 12.4%. sPAP was 46 ± 20.1 mm Hg preoperatively, sPAP was 40.6 ± 9.4 mm Hg postoperatively, NA postoperatively was 12 ± 10 μg/min, NA peak was 18 ± 11 μg/min, operation time was 275 ± 92 minutes, CPB was 145 ± 49 minutes, ICU stay was 2.4 ± 2.4 days, hospital stay was 10.8 ± 3.5 days, cell saver blood transfusion was 736 ± 346 mL, intraoperative transfusions were 2.5 ± 1.6. Two patients needed postoperative transfusions. A total of 19 patients were extubated at the 1st postoperative day, 2 patients at the 2nd day, and 1 at the 4th postoperative day. Two patients required a pacemaker. No reintubation, no in-hospital mortality, and one reoperation because of bleeding complications. Conclusion Correction of mild-to-moderate TR at the time of MV repair does maintain TV function and avoid right ventricular dysfunction in the early postoperative period improving the clinical outcome.

Cardiopulmonary Bypass Techniques and Clinical Outcomes in Beijing Fuwai Hospital: A Brief Clinical Review

The purpose of this study is to briefly summarize cardiopulmonary bypass (CPB) techniques and clinical outcomes in Beijing Fuwai Hospital. This article introduces routine CPB techniques in Fuwai Hospital, including CPB instruments, circuit setup, priming, conventional CPB management, myocardial protection, deep hypothermic circulatory arrest, ultrafiltration, autologous cell saver blood transfusion, and extracorporeal membrane oxygenation (ECMO). Clinical outcomes and further improvements of CPB management are also discussed. In 2008, 7,607 cases of cardiac surgery were performed in Fuwai Hospital, including congenital heart disease (48.33%), coronary artery disease (23.30%), rheumatic heart disease (19.45%), blood vessel disease (5.90%), reoperative surgery (1.70%), and other diseases (1.33%). The use of off-pump coronary artery bypass grafting (CABG) in isolated CABG was >50%. Thirty-eight cases of heart transplantation were also included. Total operative mortality in 2008 was 1.2%. Average postoperative stay was 9.5 days. CPB time was <120 minutes in >70% of the patients, and aortic cross-clamping time was <60 minutes in >50% of the cases. The self-recovery rate in the blood cardioplegia group (69.50%) was lower than the crystalloid cardioplegia group (97.40%). Thirty-five patients underwent cardiac surgery, and one patient from the cardiac internal medicine wards required ECMO support. Twenty-seven patients (75%, mean support time: 123.6 ± 54.1 hours) were weaned off ECMO successfully and discharged without severe complications. In conclusion, clinical CPB protocol used in Beijing Fuwai Hospital is a safe, simple, and conventional CPB management system that is suitable for practical clinical application in China. Further optimization is still needed to improve perfusion quality.

Neurocognitive Changes After Coronary Bypass Surgery

In this issue of Circulation , Djaiani and associates report that the processing of shed blood with a cell saver resulted in a significant reduction in postoperative neurocognitive dysfunction after coronary artery bypass surgery (CABG) in elderly patients.1 The authors further implied that this significant improvement in neurocognition was a result of less lipid embolization in those patients in whom a cell saver was used. The study was a randomized double-blinded trial that compared the use of a cell saver with cardiotomy suction (defined as control). Cardiotomy suction is a standard component of cardiopulmonary bypass (CPB), in which shed blood in the mediastinum is suctioned to a venous reservoir, where it is collected and then periodically reinfused through the arterial circuit to the patient. This technique was not used in patients in the cell saver group, but rather shed blood was suctioned via the cell saver system and processed, and red blood cells alone were infused to the patient through a similar arterial circuit. A standard 32-μm filter was used in the arterial pressure line in both groups. Article p 1888 Elderly patients who underwent CABG were chosen because it has been documented that these individuals are at increased risk to develop neurological dysfunction after cardiac surgery. The study was powered (n=209) to see a 50% reduction in cognitive dysfunction with additional patients added (for a total of 226 patients) to compensate for potential drop out, which turned out to be similar in both groups. The primary end point of neurocognitive evaluation was based on a battery of standardized and validated tests used to assess neuropsychological outcome. Evaluation was done at baseline and on follow-up at 6 weeks. In addition to neurocognitive decline, Figure 1 in Djaiani et al also demonstrates improvement in the battery of 12 tests documenting …

Effects of cell saver autologous blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing cardiac surgery on- versus off-cardiopulmonary bypass: a randomised trial☆

Off-pump CABG is potentially associated with reduced intraoperative blood loss and homologous blood transfusion in comparison to on-pump CABG. In this randomised controlled study we investigated the effects of autologous cell saver blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing CABG on- versus off-CPB. Eighty patients were randomised into one of four groups: (A) on-CPB with cell saver blood transfusion (CSBT), (B) on-CPB without CSBT, (C) off-pump with CSBT and (D) off-pump without CSBT. Volume of intraoperative autologous blood transfusion, postoperative mediastinal blood loss and homologous blood transfusion requirements were measured. Homologous blood was transfused when haemoglobin concentration fell below 8 g/dl postoperatively. Pre- and postoperatively prothrombin time and partial thromboplastin time were measured. Preoperative patient characteristics were well matched among the four groups. The amount of salvaged mediastinal blood available for autologous transfusion was significantly higher in the on-pump group (A) compared to the off-CPB group (C) (433+/-155 ml vs 271+/-144 ml, P=0.001). Volume of homologous blood transfusion was significantly higher in group B vs groups A, C and D (595+/-438 ml vs 179+/-214, 141+/-183 and 230+/-240 ml, respectively, P<0.005). The cell saver groups (A and C) received significantly less homologous blood than the groups without cell saver (160+/-197 ml vs 413+/-394 ml, respectively, P<0.005). Patients undergoing off-CPB surgery received significantly less homologous blood than those undergoing on-CPB CABG irrespective of cell saver blood transfusion (184+/-214 ml vs 382+/-397 ml, P<0.05). Postoperative blood loss was similar in the four groups (842+/-276, 1023+/-291, 869+/-286 and 903+/-315 ml in groups A to D, respectively, P>0.05). Clotting test results revealed no significant difference between the groups. There was no significant difference in postoperative morbidity between groups. Off-pump CABG is associated with significant reduction in intraoperative mediastinal blood loss and homologous transfusion requirements. Autologous transfusion of salvaged washed mediastinal blood reduced homologous transfusion significantly in the on-CPB group. Cell saver caused no significant adverse impact on coagulation parameters in on- or off-CPB CABG. Postoperative morbidity and blood loss were not affected by the use of CPB or autologous blood transfusion. We recommend the use of autologous blood transfusion in both on- and off-pump CABG surgery.

Carbon Monoxide Levels in Cell Saver Salvaged Blood Exposed to Electrocautery During Lumbar Spine Surgery

Carboxyhemoglobin levels were measured in patients undergoing posterior lumbar spine surgery with use of intraoperative cell saver blood salvage. Increased carboxyhemoglobin levels were demonstrated in cell saver salvaged blood. Systemic blood carboxyhemoglobin levels increased with cell saver blood transfusion. No patient demonstrated clinical effects of carbon monoxide toxicity.