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5-Year experience of blood transfusion in patients undergoing isolated Aortic Valve Replacement using Miniaturised Extra Corporeal Circulation
sanjay asopa, Mark Bennett, Gerry Webb, Clinton Lloyd.
Derriford Hospital, Plymouth, United Kingdom.

OBJECTIVE: Miniaturised extra corporeal circulation (MECC) has been reported to reduce the need for blood transfusion in patients undergoing isolated Aortic Valve Replacement (AVR) with the use of cardiopulmonary bypass in a number of small studies. The objective of our study was to review the usage of blood and blood products in patients undergoing AVR in our centre over a 5-year period using both standard (SCPB) and MECC circuits.
METHODS: We identified 465 patients who underwent first time, elective and urgent isolated AVR at our institution between April 2008 and April 2013 under supervision of 6 surgeons, 5 used SCPB and 1 used MECC. Data was retrospectively collected with electronic blood bank data and analysed. 355 patients underwent isolated AVR using SCPB, 110 patients underwent AVR using the MECC circuit with retrograde autologous priming. Activated clotting times were kept greater than 400s for both groups.
RESULTS: Both groups were matched for all preoperative risks including gender, age, additive EuroScore (4.3±2.1 vs. 4.3±1.9; p=0.901). The operative variables demonstrated no significant difference in the bypass (75.76±14.08 vs. 77.79±20.89; p=0.08) and cross-clamp (56.07±11.63 vs. 60.31±40.50; p=0.17) times between groups. There was no difference in operative mortality between MECC and SCPB with (n=2, 1.8% vs. n=1, 0.3%; p= 0.24) or postoperative length of stay (9.1±7.2 vs. 9.1± 7.0 days). There was reduced use of Red Blood Cells (RBC) transfused with MECC compared to SCPB (15.45% vs. 26.47%; p=0.019). Odds ratio estimate (OR) =0.508. However there was no significant difference in the amount of fresh frozen plasma used in both groups (p=0.64). There was no difference in the long term survival in both groups at 5 years (94.55% vs 93.18%; p=0.703).
CONCLUSIONS: In this large series of patients over a 5-year period we demonstrated a significant reduction in the use of blood for AVR patients using the MECC circuit. The odds of transfusion in patients undergoing AVR with the MECC circuit are 49% less than the SCPB.

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