• Journal of Chest Surgery
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• v.23 no.2
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• pp.260-267
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• 1990

During a eight month period[from December, 1988 to July, 1989], a series of 35 adults undergoing redo-valve replacement or coronary artery bypass grafting was selected to an autotransfusion group[n=10] or a control group[n=25]. The Cell Saver System[Haemonetics Corp., Graintree, Mass] was employed for autotransfusion. With this system, all blood shed in the operative field before and after cardiopulmonary bypass and remained in cardiotomy reservoir after cardiopulmonary bypass was aspirated by means of a locally heparinized collecting system. After the salvaged blood was centrifuged, the resulting red cell concentrate subsequently reinfused. The patients receiving autologous blood required significantly less banked homologous blood than their controls[3213k1020 ml and 506051931 ml, respectively: p=0.001] There were no clinical infections in the autotransfusion group, although 40% of the cultures of processed blood were positive. And there was no apparent intergroup difference of the clinical and the hematologic and hemostatic laboratory findings. We conclude that autotransfusion using cell saver is effective for saving the homologous blood transfusion in cardiac surgery.

• Journal of Chest Surgery
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• v.26 no.4
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• pp.255-259
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• 1993

The efficacy of the autotransfusion system is a reducing the need of intraoperative and postoperative transfusion in cardiovascular surgery. Between January 1990 and December 1991, we experienced 23 cases of autotransfusion using Haemonetic Cell Saver in cardiovascular surgery [Experimental group]. Another 13 cases which were taken similiar operations without Cell Saver during same period [Control group]. The amounts of blood transfused are 4.23 1.84 units in Control group, 2.82 1.84 units in Experimental group. Postoperatively, both groups showed decreased platelet counts, mild prolongation of prothrombin and partial thromboplastin time compred to preoperative value [P<0.001], but there were no significant differences between two group [P=NS]. Plasma hemoglobin was markedly increased in Experimental group compared with Control group [p<0.05]. In Experimental group, amount of average processed blood by Cell Saver was 700ml of which composition was hemoglobin 17mg/dl, hematocrit 50.0%, RBC 5,590,000/ml, WBC 7500/ml, and platelet 40,000/ml. The culture of the processed blood revealed no growth of the organisms. Conclusively, Cell Saver autotransfusion system is a simple, safe, and cost effective method especially in the cases associated with massive bleeding. However, it requires familiarity with system, gentle manipulation of suction tip, and careful selection of candidates to obtain maximal benefits .

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1312-1317
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• 1992

Autologous blood transfusion is a common method of reducing the need for homologous blood transfusion during cardiac operations. Between June 1991 and May 1992, 12 cases [Group I] were experienced autologous blood transfusion using Cell Saver undergoing double valve replacement or redo-valve replacement. Control group [N=12, Group II] was selected to above similar operation during same period. The Cell Saver system [Haemonetics Corp.] was employed for autologous blood transfusion. The blood shed in the operative field before and after cardiopulmonary bypass and remained cardiotomy reservior was aspirated by means of a locally heparinized collecting system. After centrifused salvaged blood, the resulting red cell concentrate reinfused subsequently. The patient receiving autologous blood transfusion required significantly less homologous blood transfusion than their control group. [Group I; 3519 $\pm$ 869, Group II; 4622 $\pm$ 856, Respectively; P=0.005] There were no clinical infections in the autotransfusion group. And there was no apparent intergroup difference of the clinical findings, hematologio datas and coagulation parameters. We conclude the autotransfusion using Cell Saver is effective for reducing of the hom-ologlous blood transfusion in cardiac surgery.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.581-585
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• 1998

Postoperative autotransfusion is known as an effective method for blood conservation. We tried to examine whether the autotransfusion of shed mediastinal blood in patients with unstable angina would be valuable for reducing postoperative homologous transfusion by observing the hourly tendency of bleeding and transfusion. Between August and October, 1997, 26 patients with unstable angina underwent coronary arterial bypass surgery by a single surgeon at Asan Medical Center. In retrospective analysis, we found 90% of the patients received homologous transfusions and 85% of them were in the intensive care unit at the same day after operation. In many patients, the cause of transfusion was not anemia but volume replacement. Mean bleeding through the chest tubes was 340 cc for the first 5 hours and 69%(18 pts) showed more than 200 cc of bleeding, the amount generally considered as a initiating point for autotransfusion. Despite the adoption of multiple methods for blood conservation, 90% of the patients needed homologous transfusion. Moreover, many of them had received unnecessary transfusions. We conclude that some kind of blood for transfusion is needed during the immediate postoperative period, and the adoption of postoperative autotransfusion may help in reducing homologous transfusion.

• Journal of Chest Surgery
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• v.28 no.2
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• pp.125-130
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• 1995

Autotransfusion system is a common method of reducing the need of intraoperative and postoperative homologous blood transfusion in cardiac operation. Between August 1991 and August 1993, a series of 51 adults undergoing open heart surgery was selected. Autotransfusion using Cell Saver [COBE Baylor Rapid Autologous Transfusion System was done with homologous blood transfusion in 15 cases [Group II or without homologous blood transfusion in 17 cases [Group III . The other 19 cases were taken without Cell Saver for control [Group I . The shed blood in the operative field, remained blood in the oxygenator after cardiopulmonary bypass, and blood drained from chest tubes in postoperative care were aspirated by means of a locally heparinized collection system. After the salvaged blood was washed and centrifuged, the processed blood subsequently reinfused. Composition of processed blood by Cell Saver was hemoglobin 16.9gm%, hematocrit 49%, RBC 5,140,000/ml, WBC 670/ml, and platelet 30,000/ml. In three group, hemoglobin, hematocrit, and platelet counts were decreased postoperatively, but no significant differences between three group. Postoperatively, the amounts of drainage from chest tubes was 543$\pm$121ml in Group I, 809$\pm$201ml in Group II, and 631$\pm$147ml in Group III. In Group II, there was large amount of drainage compared with Group I [p<0.05 . The amount of homologous blood transfused was 1116$\pm$219 ml in Group I, 791$\pm$183 ml in Group II [p<0.05 . The homologous blood was not transfused in 17 cases [53% with Cell Saver.Preoperative and postoperative, coagulation parameters showed no significant differences between three group. And there was no complication related to Cell Saver. We conclude that the autotransfusion using Cell Saver is effective for reducing the homologous blood transfusion in cardiac surgery.

• Journal of Chest Surgery
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• v.31 no.1
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• pp.28-31
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• 1998

Homologous blood transfusion entails substantial risks, including allergic reactions, transmission diseases such as hepatitis, acquired immunodeficiency syndrome. Autotransfusion system is a common method of reducing the need for homologous blood transfusion during cardiac operation. Between July 1993 and July 1995, a series of 40 patients undergoing open heart surgery was selected to an autotransfusion group(n=20) or a control group(n=20). The cell saver system(AT1000, Electromedics, Englewood, CO, USA) was employed for autotransfusion. With this system, shed blood in operative field during cardiopulmonary bypass(CPB) and remained blood in cardiotomy reservior after CPB was aspirated by means of a locally heparinized collecting system. After centrifuge salvaged blood, the resulting red cell concentrate reinfused subsequently. The amounts of blood loss were 766.5$\pm$121.3 ml in cell saver group, 770.1$\pm$113.6 ml in control group, and there were no significant differences between two groups(P=NS). The amounts of blood transfused were 2.91$\pm$1.72 units in cell saver group, 4.82$\pm$1.72 units in control group. Composition of processed blood by cell saver was hemoglobin 17.4 gm%, hematocrit 56.4%, RBC 5,780,000/ul, WBC 9,900/ul, and platelet 33,000/ul. There was no complication related to cell saver. Conclusively, cell saver autotransfusion system is safe, effective method for reducing the homologous blood trasfusion in cardiac surgery.

• Proceedings of the KTCVS Conference
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• 1993.06a
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• pp.71-73
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• 1993

• Journal of Chest Surgery
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• v.25 no.10
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• pp.1048-1054
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• 1992

With use of a simple, inexpensive and nonpharmacological program for blood conservation, 24 consecutive patients underwent elective or urgent coronary artery bypass grafting without need of homologous red cell transfusions and /or fresh frozen plasma transfusions in 16 patients[66.7%]. Left internal mammary artery graftings were done in 18 patients[75%], with supplemental saphenous vein grafts in all. Intraoperatively, autologous heparinized blood was removed before bypass and retransfused at the conclusion of ext-racorporeal circulation. The volume remaining in the oxygenator and tubing set was returned without cell processing or hemofiltration. Using the hard-shell cardiotomy reservoir from the oxygenator, autotransfusion of the shed mediastinal blood was continued hourly by the next early;norning. The mean postoperative mediastinal blood loss was 364$\pm$234ml, whereas 553$\pm$383ml was autotransfused. 4 patients [16.7%] received homologous blood and an additional 4 patients[16.7%] fresh frozen plasma. Thus, in total, 16 patients[66.7%] were not exposed to any homologous blood products during the hospital stay. At discharge, the mean hemoglobin concentration was 10.3$\pm$1.6g /dl. Postoperative complications were few and there was no hospital death.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.473-479
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• 2009

Background: Retrograde autologous priming (RAP) is known to be useful in decreasing the need of transfusions in cardiac surgery because it prevents excessive hemodilution due to the crystalloid priming of cardiopulmonary bypass circuit. However, there are also negative side effects in terms of blood conservation. We analyzed the intraoperative blood-conserving effect of RAP and also investigated the efficacy of autotransfusion and ultrafiltration as a supplemental method for RAP. Material and Method: From January 2005 to December 2007, 117 patients who underwent isolated coronary artery bypass operations using cardiopulmonary bypass (CPB) were enrolled. Mean age was 63.9$\pm$9.1 years (range 36$\sim$83 years) and 34 patients were female. There were 62 patients in the RAP group and 55 patients in he control group. Intraoperative autotransfusion was performed via the arterial line. RAP was done just before initiating CPB using retrograde drainage of the crystalloid priming solution. Both conventional (CUF) and modified (MUF) ultrafiltrations were done during and after CPB, respectively. The transfusion threshold was less than 20% in hematocrit. Result: Autotransfusions were done in 79 patients (67.5%) and the average amount was 142.5$\pm$65.4 mL (range 30$\sim$320 mL). Homologous red blood cell (RBC) transfusion was done in 47 patients (40.2%) and mean amount of transfused RBC was 404.3$\pm$222.6 mL. Risk factors for transfusions were body surface area (OR 0.01, 95% CI 0.00 $\sim$ 0.63, p=0.030) and cardiopulmonary bypass time (OR 1.04, 95% CI 1.01 $\sim$ 1.08, p=0.019). RAP was not effective in terms of the rate of transfusion (34.5% vs 45.2%, p=0.24). However, the amount of transfused RBC was significantly decreased (526.3$\pm$242.3ml vs 321.4$\pm$166.3 mL, p=0.001). Autotransfusion and ultrafiltration revealed additive and cumulative effects decreasing transfusion amount (one; 600.0$\pm$231.0 mL, two; 533.3$\pm$264.6 mL, three; 346.7$\pm$176.7 mL, four; 300.0$\pm$146.1 mL, p=0.002). Conclusion: Even though RAP did not appear to be effective in terms of the number of patients receiving intraoperative RBC transfusions, it could conserve blood in terms of the amount transfused and with the additive effects of autotransfusion and ultrafiltration. If we want to maximize the blood conserving effect of RAP, more aggressive control will be necessary - such as high threshold of transfusion trigger or strict regulation of crystalloid infusion, and so forth.

• Journal of Chest Surgery
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• v.26 no.2
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• pp.108-114
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• 1993

The risks of homologous blood transfusion are well documented and recently increased with the emergence of acquired immunodeficiency syndrome. This is a report concerning 29 consecutive adult with no blood conservation patients (Group I) who had an elective cardiac operations. A similar group of 29 patients operated on 1992 but with blood conservation (Group II). In I of Group I patients and 15 of Group II patients, no homologous blood products were required. Group II patients used significantly less fresh frozen plasma (2.05${\pm}$0.68 unit versus 6.52${\pm}$0.72 unit, p<0.05) and the homologous blood transfusion (0.42${\pm}$0.9 unit versus 3.64${\pm}$0.17 unit, p<0.05) than Group I patients. Group II patients had also significantly less postoperative bleeding (338${\pm}$39.9 ml versus 585${\pm}$93.0 ml, p<0.05) than Group I patients. Group II patients recieved 460${\pm}$62.6 ml of mediastinal shed blood in acquired group. In conclusion, a simple and inexpensive blood conservation program, mainly combining autologous blood removal before bypass, retransfusion of the volume remaining in the oxygenator, and consistent autotransfusion of mediastinal shed blood has enabled us to avoid infusion of homologous blood in 15/29 patients of Group II patients. No side effects or complicatinos could be related to the blood conservation program.