DOES INTRAOPERATIVE AUTOLOGOUS BLOOD TRANSFUSION IN CORONARY ARTERY BYPASS GRAFTING SURGERY REDUCE THE INCIDENCE OF POSTOPERATIVE MEDIASTINAL BLEEDING?

Objective: Mediastinal bleeding and blood transfusion have been an important accompaniment of open heart surgery. Increasing attempts are being made to minimize blood loss and blood transfusion in cardiac surgery. We investigated the effect of intraoperative autologous donation (IAD) on need for homologous transfusion post-coronary artery bypass graft surgery (CABG).
Methods: 202 adult patients scheduled for elective CABG operation were randomly assigned to IAD (n=101) or control groups (n=101). We obtained 500ml fresh whole blood from the IAD patients while the patients were prepared for anesthesia in the operating room. This amount of blood was replaced with Ringer's solution. After completion of the operation and neutralization of heparin, this blood was re-infused to the patients. The amount of bleeding and infused blood products were measured and compared in both groups.
Results: The present study demonstrated that IAD did not significantly reduce post-operative mediastinal bleeding, although it had a positive effect on reducing homologous transfusion.
Conclusions: It seems that IAD can reduce homologous blood transfusion (although not significantly), but for prevention of bleeding some simple points such as mild hypothermia instead of moderate hypothermia, reduced heparin dose with newer tubing systems and oxygenators and precise hemostasis are more prominent.