Blood conservation in small adults undergoing valve surgery

Abstract Objectives: A substantial reduction in transfusion requirements for cardiac surgical procedures has been reported. Many of these reports have been described in patients undergoing coronary artery bypass grafting. Patients suffering from rheumatic heart disease in India are usually small and also anemic. This study was conducted to assess blood conservation methods for cardiac valve surgery in this subset of patients. Design: This was a prospective, randomized study. Setting: The study was performed in a New Delhi tertiary care hospital, and the patients were referred from the northern states of India. Participants: One hundred fifty consecutive patients undergoing elective valve surgery using cardiopulmonary bypass were included. The mean age was 27.7 years and mean weight was 45.2 kg. Interventions: The patients were divided into three groups of 50 each. Group 1 received autologous fresh blood donatedbefore bypass, and both a cell saver and membrane oxygenatorwere used. The oxygenator contents at the end of perfusion were processed by cell saver. Group 2 patients were reinfused with autologous blood only, and group 3 was a control group. In groups 2 and 3, the blood that remained in the oxygenator at the conclusion of cardiopulmonary bypass was reinfused. A hematocritof less than 25% was considered an indication for transfusion in the postoperative period. Measurements and Main Results: The mean preoperative hematocritwas 35.5%. A mean of 361.1 mL of autologous blood was collected from group 1 and 303.0 mL from group 2. Group 1 required 15 units of bank blood, group 2, 90 units ( p p Conclusions: In this unique group of patients whose mean body weight was only 45 kg, autologous blood alone did not decrease blood bank requirements but when combined with a cell saver and membrane oxygenatorgreatly reduced the need for donor blood.