Retrograde autologous priming (RAP) as a safe and easy method to reduce haemodilution and transfusion requirements during cardiac surgery - Comparison between RAP, Standard and Miniaturised Extracorporeal Circulation -
Maximilian Halbe, Chris Probst, Armin Welz.
Univercity of Bonn, Bonn, Germany.
OBJECTIVE: In the last decade, there have been some exciting developments in the design of cardiopulmonary bypass (CPB) systems to reduce the adverse clinical effects of the heart lung machine. Mini- extracorporeal circulation (MECC) is one example that has shown promising clinical results. Also the technique of retrograde autologous priming (RAP) of the CPB circuit has regained interest as an easy method in order to decrease haemodilution.
The purpose of our study was to investigate the impact of RAP on the intraoperative haematocrit level and the consequent need for blood transfusion in comparison to standard CPB (SCPB) and a Minimal System (Terumo ROC Safe®) in elective coronary artery bypass (CABG) patients operated by a single surgeon.
METHODS: Data were retrospectively collected on 3 cohorts of adult CABG patients operated on by a single surgeon.
Group RAP (n = 30) of patients operated using the RAP and control groups of patients operated using
SCPB standard crystalloid method (n = 30) and ROC Safe® (n=30).
Intra- and postoperative data of the three groups were obtained and analysed by using SPSS® for Windows. A p- value of p< 0.05 was considered significant.
RESULTS: There was no significant difference in the demographic data of the three groups.
The priming volume was SCPB: 1608 ±181 ml, RAP: 946 ± 212 ml and ROCSafe®: 567 ± 98 ml (p<0.001).
There were significant differences in hemodilution (p<0.05), intraoperative transfusion requierements (p<0,001), intraoperative lactate levels (p<0.05), urinary excretion (p<0.05) and postoperative transfusion requirements (p<0.05). There were no differences between the 3 groups in the incidence of several other postoperative complications.
CONCLUSIONS: In conclusion, RAP is a safe and low cost technique in reducing the priming volume of the cardiopulmonary bypass system, causes less haemodilution and reduces the need for intra- and postoperative blood transfusion
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