Cardiac Surgery Department, Virgen de la Arrixaca University Hospital 30120 Murcia Spain.
Department of Health and Social Sciences, Murcia University 30120 Murcia Spain.
J Extra Corpor Technol. 2023 Mar 24;55(1):30-38. doi: 10.1051/ject/2023004. eCollection 2023 Mar.
: New era of cardiac surgery aims to provide an enhanced postoperative recovery through the implementation of every step of the process. Thus, perfusion strategy should adopt evidence-based measures to reduce the impact of cardiopulmonary bypass (CPB). Hematic Antegrade Repriming (HAR) provides a standardized procedure combining several measures to reduce haemodilutional priming to 300 mL. Once the safety of the procedure in terms of embolic release has been proven, the evaluation of its beneficial effects in terms of transfusion and ICU stay should be assessed to determine if could be considered for inclusion in Enhanced Recovery After Cardiac Surgery (ERACS) programs. : Two retrospective and non-randomized cohorts of high-risk patients, with similar characteristics, were assessed with a propensity score matching model. The treatment group (HG) ( = 225) received the HAR. A historical cohort, exposed to conventional priming with 1350 mL of crystalloid confirmed the control group (CG) ( = 210). : Exposure to any transfusion was lower in treated (66.75% vs. 6.88%, < 0.01). Prolonged mechanical ventilation (>10 h) (26.51% vs. 12.62%; < 0.01) and extended ICU stay (>2 d) (47.47% vs. 31.19%; < 0.01) were fewer for treated. HAR did not increase early morbidity and mortality. Related savings varied from 581 to 2741.94 $/patient, depending on if direct or global expenses were considered. : By reducing the gaseous and crystalloid emboli during CPB initiation, HAR seems to have a beneficial impact on recovery and reduces the overall transfusion until discharge, leading to significant cost savings per process. Due to the preliminary and retrospective nature of the research and its limitations, our findings should be validated by future prospective and randomized studies.
: 心脏外科的新时代旨在通过实施该过程的每一步骤来提供增强的术后恢复。因此，灌注策略应采用循证措施来减少体外循环（CPB）的影响。血液逆行再充氧（HAR）提供了一种标准化程序，结合了多种措施，将血液稀释性再充氧减少到 300ml。一旦该程序在栓塞释放方面的安全性得到证实，就应评估其在输血和 ICU 停留方面的有益效果，以确定是否可以考虑将其纳入心脏手术后增强恢复（ERACS）计划。 : 评估了具有相似特征的两个高危患者的回顾性和非随机队列，并使用倾向评分匹配模型进行匹配。治疗组（HG）（n=225）接受 HAR。历史队列中，有 1350ml 晶体液暴露于常规引血的患者被确认为对照组（CG）（n=210）。 : 治疗组的输血暴露率较低（66.75%比 6.88%，<0.01）。HAR 治疗组机械通气时间延长（>10 小时）（26.51%比 12.62%，<0.01）和 ICU 停留时间延长（>2 天）（47.47%比 31.19%，<0.01）的比例较低。HAR 并未增加早期发病率和死亡率。HAR 相关的节省金额因考虑直接费用或总费用而异，范围在 581 至 2741.94 美元/患者。 : 通过减少 CPB 启动时的气体和晶体栓塞，HAR 似乎对恢复有有益影响，并减少了整个输血直至出院，从而使每个过程都节省了大量成本。由于研究的初步性和回顾性及其局限性，我们的发现应通过未来的前瞻性和随机研究来验证。
