Tan Nguyen Luong, Corbineau Hervé, Phu Bui Duc, Verhoye Jean-Philippe
Cardiovascular and Thoracic Surgery Department, Hue Central Hospital, Vietnam.
Asian Cardiovasc Thorac Ann. 2012 Oct;20(5):539-43. doi: 10.1177/0218492312439479.
Off-pump coronary artery bypass surgery should have a significantly lower risk of postoperated bleeding than on-pump surgery. However, the use of a cell saver has been considered necessary, with significant additional cost incurred. Can we consider performing off-pump coronary artery bypass surgery without a cell saver?
A prospective observational study was performed in 68 consecutive patients operated on for 2- or 3-vessel coronary lesions by the off-pump technique.
The mean number of distal anastomoses was 2.7 ± 0.7. Both internal thoracic arteries were used in 45 patients, and sequential revascularization was performed in 27, with 140 (77.8%) arterial grafts. Cell savers were used in 21 (30.9%) patients. In these 21 patients, the mean volume retransfused after treatment was 315 ± 177 mL. Postoperatively, 11 (16.2%) patients were transfused with packed red blood cells, with a mean volume of 636 ± 234 mL per patient. The 2 factors identified as associated with a higher risk of autotransfusion were female sex and a lower preoperative hemoglobin.
The use of a cell saver in off-pump surgery is useless in most cases. Careful surgical hemostasis is essential to limit hypovolemia.
非体外循环冠状动脉搭桥手术术后出血风险应显著低于体外循环手术。然而，使用血液回收机被认为是必要的，这会产生显著的额外费用。我们能否考虑在不使用血液回收机的情况下进行非体外循环冠状动脉搭桥手术？
对68例连续接受非体外循环技术治疗2支或3支冠状动脉病变的患者进行了前瞻性观察研究。
远端吻合口的平均数量为2.7±0.7个。45例患者使用了双侧胸廓内动脉，27例进行了序贯血运重建，共使用了140支（77.8%）动脉移植物。21例（30.9%）患者使用了血液回收机。在这21例患者中，处理后回输的平均血量为315±177毫升。术后，11例（16.2%）患者输注了浓缩红细胞，平均每位患者输注量为636±234毫升。确定与自体输血风险较高相关的两个因素是女性性别和术前血红蛋白水平较低。
在大多数情况下，非体外循环手术中使用血液回收机并无用处。仔细的手术止血对于限制血容量不足至关重要。
