Does retrograde autologous priming during coronary artery bypass grafting reduce blood transfusions?

OBJECTIVE

Coronary artery bypass grafting is associated with a significant risk of blood transfusion. The clinical efficacy of retrograde autologous priming, a potential blood conservation strategy, lacks consensus. We aim to evaluate the effect of retrograde autologous priming on transfusion requirements and clinical outcomes in patients undergoing coronary artery bypass grafting.

METHODS

A retrospective review was conducted on all patients undergoing on-pump, isolated coronary artery bypass grafting between October 2018 and March 2023 at a single institution. Those undergoing retrograde autologous priming were identified and compared with non-retrograde autologous priming cases. Wilcoxon rank-sum and chi-square analyses were used to analyze continuous and categorical outcomes, respectively. Risk-adjusted multivariable logistic regression was performed.

RESULTS

A total of 1109 patients met inclusion criteria, with 332 (29.9%) receiving retrograde autologous priming. At baseline, patients in the retrograde autologous priming group had higher preoperative hemoglobin (14.0 g/dL vs 13.7 g/dL, .03), higher nadir intraoperative hemoglobin (10.2 g/dL vs 9.7 g/dL, .0), and less total crystalloid use (900 mL vs 110 0 mL, .01) in the operating room. On risk-adjusted analysis, including adjustment for preoperative hemoglobin levels, retrograde autologous priming was found to significantly reduce the risk of postoperative blood transfusion (odds ratio, 0.54, .01) and postoperative prolonged ventilation (odds ratio, 0.47, .02).

CONCLUSIONS

Use of retrograde autologous priming may result in fewer transfusions and thus potentially prevent transfusion-associated risks such as prolonged ventilation. Potential mechanisms include avoidance of volume overload and transfusion-related acute lung injury. Retrograde autologous priming should be considered in appropriately selected patients undergoing cardiac surgery.