Anesthesiology and Reanimation Department, Ankara City Hospital, Ankara, Turkey.
Department of Biology, Faculty of Science, The University of Istanbul, Istanbul, Turkey.
Ann Card Anaesth. 2021 Oct-Dec;24(4):427-433. doi: 10.4103/aca.ACA_193_20.
Although conventional cardiopulmonary bypass (cCPB) is still the most widely used method in open heart surgery, methods such as retrograde autologous priming (RAP) are increasingly popular in terms of limiting hemodilution. Our hypothesis is that the use of the RAP method in aortic surgery may result in a limitation of hemodilution and a decrease in fHb levels. For this purpose, plasma free hemoglobin (fHb) levels were investigated in adult open aortic arch repair with axillary artery cannulation patients using cCPB and rRAP methods.
In this study, a total of 36 patients undergoing aortic surgery using rRAP and standard cCPB were investigated. Measurements were performed at five time points: After induction of anesthesia, 5 minute of CPB, 10 minute of antegrade cerebral perfusion, 30 minute after declamping of aorta, and at sternum closure. Besides hemodynamic variables, arterial blood gas analysis and postoperative variables, patients were assessed for fHb levels.
The rRAP group had a significantly lower increase in fHb levels in T3, T4, and T5 time points, when compared to the cCPB group (p = 0.002, 0.047, 0.009, respectively). There was no significant difference between the rRAP and cCPB groups in other intraoperative, and postoperative variables. Also, it was observed that rRAP did not make a difference in terms of blood and blood product transfusion.
In this study, in patients undergoing aortic surgery, a reduction in the increase of fHb was observed with the rRAP method which is a simple procedure that does not require high cost or advanced technology.
虽然传统的体外循环（cCPB）仍然是心脏直视手术中最广泛使用的方法，但逆行自体预充（RAP）等方法在限制血液稀释方面越来越受欢迎。我们的假设是，在主动脉手术中使用 RAP 方法可能会限制血液稀释并降低游离血红蛋白（fHb）水平。为此，我们研究了使用腋动脉插管的成人升主动脉弓修复术患者中，使用 cCPB 和 rRAP 方法时血浆游离血红蛋白（fHb）水平的变化。
本研究共纳入 36 例行 rRAP 和标准 cCPB 的主动脉手术患者。在五个时间点进行测量：麻醉诱导后、CPB 5 分钟、顺行脑灌注 10 分钟、主动脉阻断后 30 分钟和胸骨关闭时。除血流动力学变量、动脉血气分析和术后变量外，还评估患者的 fHb 水平。
与 cCPB 组相比，rRAP 组在 T3、T4 和 T5 时间点的 fHb 水平升高明显较低（p = 0.002、0.047、0.009）。rRAP 组和 cCPB 组在其他术中及术后变量方面无显著差异。此外，rRAP 对输血和血制品的需求没有影响。
在本研究中，与 cCPB 相比，在接受主动脉手术的患者中，rRAP 方法可降低 fHb 水平的升高，该方法简单，无需高成本或先进技术。
