Efficacy and safety of a blood conservation program including low-dose aprotinin in routine myocardial revascularization
Schönberger, J.P.; Woolley, S.; Tavilla, G.; Berreklouw, E.; Bredée, J.J.; Mashhour, Y.A.; Van Straten, B.H.; Bavinck, J.H.; Frietman, P.A.; Everts, P.A.; Wildevuur, C.R.
Journal of Cardiovascular Surgery 37(1): 35-44
1996
ISSN/ISBN: 0021-9509 PMID: 8606206 Document Number: 465450
Objectives: We attempted to analyze the efficacy and safety of an extensive blood saving program applied in a large cohort of patients. Measures: Blood saving included reinfusion of intra-operative predonated blood, aprotinin (2 million KIU) in the prime solution, reinfusion of any residual volume, postoperative acceptance of normovolemic anemia (hematocrit gtoreq 25%) and autotransfusion of shed blood. Setting, experimental design and patients: In our general hospital with a heart surgery service (1150 cases/year), we studied the records of 527 non-selected consecutive patients, who were prospectively treated with this program being applied in primary myocardial revascularization between. Results: We avoided the use of donor blood in 86.9% of the patients requiring a mean of 0.2+-0.01 unit of donor blood per patient. No repeat thoracotomy for bleeding was needed in any patient. Univariate analysis revealed that female gender, a low level of hematocrit, high age, a small stature, weight, body surface area, and red cell volume prebypass significantly (p lt 0.001) were correlated to treatment with donor blood. Multiple regression showed that a small red cell volume and a low prebypass hematocrit were the most (p lt 0.0001) significant predictors for the use of donor blood. Observing a low incidence of morbidity (myocardial infarction, gastrointestinal, neurological thromboembolic, renal and wound complications), the safety of this program seems to be emphasized. Conclusions: Extensive blood saving including low-dose aprotinin reduced effectively and safely the need for donor blood in a large cohort of patients,but not in those patients with a small red cell volume and low hematocrit preoperatively.