Coronary artery bypass surgery with minimal use of homologous blood. Effects of a simple and inexpensive blood conservation programme.

Restriction of donor blood transfusions in cardiac surgery should decrease the risk of infective contamination and antigenicity. Following a simple, systematic and inexpensive blood conservation program, we report on 250 consecutive patients undergoing elective coronary artery bypass surgery, 247 (98.6%) of whom did not need homologous blood transfusions. At least one internal mammary artery was grafted in all but one patient, in combination with saphenous vein grafts. Intraoperatively, autologous heparinized blood was removed before bypass and retransfused at the conclusion of extracorporeal circulation. The remaining volume of the oxygenator and tubing set was retransfused without any cell processing or hemofiltration. Using the hard-shell cardiotomy reservoir from the heart lung machine, autotransfusion of the shed mediastinal blood was continued hourly up to 18 h after surgery. The mean postoperative mediastinal bleeding was 622 +/- 287 ml, of which 589 +/- 296 ml was autotransfused. Five patients (2.0%) needed re-exploration for bleeding, and three of these received 1-4 units of homologous blood. No other patients needed red cell transfusions. Seven patients were given a mean of 2.6 units of fresh frozen plasma because of coagulopathy. Thus, altogether 240 patients (96%) were not exposed to any homologous blood products during their hospital stay. Morbidity was low. At discharge, the mean hemoglobin concentration was 12.0 +/- 1.4 g/dl and the mean hematocrit 36.0 +/- 4.2%. There were no deaths.