Reduction of Homologous Transfusions in Open-Heart Surgery

Abstract

Use of homologous blood is relatively frequent in cardiac surgery and represents a potential risk for sensitivity or infective contamination. A prospective study on 744 patients (operated on before September, 1986, and considered as the control group) revealed that the incidence of posttransfusion hepatitis was 12.7% (mean overall blood loss was 1270±115 mL; bank-blood-transfused patients comprised 91.9% of the group; and bank-blood-transfused units averaged 8.6/patient). From September, 1986, to December, 1990, 924 patients underwent elective open-heart operations. Autotransfusion only was used in group A (400 patients). Aprotinin was added to autotransfusion in group B (192 patients). Aprotinin only was used in group C (332 patients). The bank blood requirement was reduced drastically in all groups. In group A, mean blood loss was 870±85 mL, and transfusions were required in 29.7% of patients with a mean bank blood unit/patient of 2.6 ± 1.8. In group B, mean blood loss was 425 ± 55 mL, and transfusions were required in 11.5% of patients, with a mean bank blood unit/patient of 1.8 ± 1.3. In group C, mean blood loss was 405 ± 45 mL, 31.9% of patients had bank blood transfusion, and mean bank blood unit/patient was 2.1±1.2. The incidence of posttransfusion hepatitis was 4.2% in group A, whereas no infective complications were found in the other groups. The basal mean hematocrit value in groups A and B was 42.1±2.7% and 41.4±2.0%, respectively, and preoperatively, after a blood withdrawal of 3 units, was, respectively, 34.8±1.9% and 33.8±1.1%. In group C the mean preoperative hematocrit value was 41.7 ±2.2%. Mean hematocrit values at discharge were similar in all three groups, ranging around 30%. Platelet count dropped in group A after surgery (-41%) and increased in the postoperative period, never reaching the basal value. Patients receiving aprotinin (groups B and C) presented a lower postoperative platelet decrease (respectively -28.6% and - 26.1 %), with a discharge value lower than basal. Autologous blood collection and aprotinin administration proved to be a well-tolerated and uncomplicated method. This represented the most important and effective blood-saving procedure in cardiac surgery, minimizing the bank blood requirement and minimizing or even eliminating posttransfusion complications.