Li Gabrielle, Wisniewski Alex M, Strobel Raymond J, Dallas Evelynn, Yount Kenan, Yarboro Leora, Singh Karen, Kern John, Teman Nicholas R, Beller Jared P
Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Va.
Department of Anesthesiology, University of Virginia, Charlottesville, Va.
JTCVS Open. 2025 Mar 28;25:126-133. doi: 10.1016/j.xjon.2025.02.023. eCollection 2025 Jun.
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.
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.
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).
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.
冠状动脉旁路移植术伴有大量输血风险。逆行自体预充作为一种潜在的血液保护策略，其临床疗效尚无定论。我们旨在评估逆行自体预充对接受冠状动脉旁路移植术患者输血需求和临床结局的影响。
对2018年10月至2023年3月在一家机构接受体外循环下单纯冠状动脉旁路移植术的所有患者进行回顾性研究。确定接受逆行自体预充的患者，并与未接受逆行自体预充的病例进行比较。分别采用Wilcoxon秩和检验和卡方分析来分析连续变量和分类变量的结局。进行风险调整的多变量逻辑回归分析。
共有1109例患者符合纳入标准，其中332例（29.9%）接受了逆行自体预充。基线时，逆行自体预充组患者术前血红蛋白水平较高（14.0 g/dL对13.7 g/dL，P = 0.03），术中最低血红蛋白水平较高（10.2 g/dL对9.7 g/dL，P = 0.00），手术室晶体液总用量较少（900 mL对1100 mL，P = 0.01）。在风险调整分析中，包括对术前血红蛋白水平进行调整后，发现逆行自体预充可显著降低术后输血风险（比值比，0.54，P = 0.01）和术后长时间通气风险（比值比，0.47，P = 0.02）。
使用逆行自体预充可能减少输血次数，从而潜在地预防诸如长时间通气等与输血相关的风险。潜在机制包括避免容量超负荷和输血相关的急性肺损伤。对于适当选择的心脏手术患者，应考虑采用逆行自体预充。
