Banked and fresh autologous blood in cardiopulmonary bypass surgery

When 50 patients having autologous transfusions of two units of blood collected intraoperatively during coronary bypass surgery were compared with 50 patients receiving only homologous donor blood, it was found that a two-unit (20%) decrease in homologous blood usage per case occurred in the group receiving the autologous blood. No decrease occurred in total units of blood used per case. In 15 patients undergoing coronary bypass surgery, in addition to the two units of autolobous blood collected during surgery, two or four units of autologous blood were obtained preoperatively and administered intraoperatively. When four units were collected, the red blood cells were frozen until just prior to surgery. Total blood usage per case remained unchanged but a 4.6 unit (41%) decrease in homologous donor blood usage was noted. Patients phlebotomized preoperatively took 325 mgm of oral iron t.i.d. through the postoperative recovery period. These patients had an average decrease in hematocrit of 4.25 to 4.3 per cent following the final phlebotomy and just prior to surgery.     

Experience of a network of transfusion coordinators for blood conservation (Ontario Transfusion Coordinators [ONTraC])

BACKGROUND: The experiences of the development of a provincial program to promote blood conservation are herein reported. STUDY DESIGN AND METHODS: Transfusion coordinators were placed in 23 Ontario hospitals. Anonymized laboratory and clinical information was collected in a defined number of all consecutive patients admitted for three designated procedures: knee arthroplasty, abdominal aortic aneurysm (AAA), and coronary artery bypass graft (CABG) surgery (n approximately 1100, 300, and 300 at each time period, respectively). RESULTS: Considerable interinstitutional variation was observed in the proportion of patients who received transfusions. At 12 months, and over the 24-month period of the project, most hospitals demonstrated decreased use of allogeneic blood; at 12 months an approximate 24 percent reduction in patients undergoing knee surgery, 14 percent in AAA, and 23 percent in CABG was obtained. In addition, patients who received transfusions received less allogeneic blood. Patients who did not receive allogeneic transfusions had lower postoperative infection rates (p < 0.05) and length of stay (p < 0.0001); allogeneic transfusion was an independent predictor of increased length of stay. The main blood conservation measures employed during this time were education, preoperative autologous donation, erythropoietin, and cell salvage. CONCLUSION: The implementation of a provincial network of transfusion coordinators was feasible and allogeneic transfusion rates declined over the period the program has been in place.     

Blood transfusion and postoperative infection in orthopedic patients

Adverse effects of the transfusion of homologous blood on tumor recurrence and resistance to bacterial infection have been reported previously, but the findings are inconclusive. A retrospective review of patients undergoing orthopedic surgery was conducted, and the rate of the postoperative infectious complications was compared among those receiving homologous blood, autologous blood, both types, or no transfusion support. An overall postoperative infection rate of 6.1 percent was observed: 6.9 percent among persons receiving homologous blood, 5.0 percent among those receiving autologous blood, 11.9 percent among those receiving both homologous and autologous blood, and 4.9 percent among those not receiving transfusions (p = 0.37). Among patients receiving homologous blood, a subset of 15 patients received homologous whole blood and had an infection rate of 20 percent. Significant predictors of postoperative infection included increasing age, spinal surgery, high admission hematocrit, and greater time in surgery. Of factors relating to transfusion, only the use of homologous whole blood was a significant predictor of postoperative infection, which suggests a detrimental effect of homologous plasma. It can be concluded that, in this group of patients undergoing relatively nontraumatic surgery, several variables that are not related to transfusion, as well as the use of homologous whole blood, were significant predictors of postoperative infection.     

A provincial program of blood conservation: The Ontario Transfusion Coordinators (ONTraC).

PURPOSE: Although often life-saving, blood transfusions are associated with significant risk to the patient and escalating costs to the blood system and hospital. Transfusions are often given unnecessarily. Blood conservation represents the use of alternatives to transfusion. The ONTraC program attempts to enhance transfusion practice outside the blood transfusion laboratory, promote blood conservation in surgery patients, and reduce allogeneic red cell use. METHODS: In the first such large scale program, funding was obtained from the Ontario MOHLTC for a Transfusion Coordinator in 23 Ontario hospitals selected based on blood utilization and geography. At specific time periods, detailed anonymized information was collected in a defined number of all consecutive patients admitted for the three designated surgical procedures: knee arthroplasty (N=approximately 1200 at each time point), abdominal aortic aneurysm (AAA; N=300 at each time) and coronary artery bypass graft (CABG) surgery (N=300 at each time point). RESULTS: Considerable inter-institutional variation was observed in the proportion of patients and amount of blood transfused. At the 12 month analysis, most, although not all, hospitals had decreased use of allogeneic blood and there was an overall 24% reduction in blood use in patients undergoing knee surgery, 14% in AAA and 23% in CABG. In addition to reduction in proportion of patients transfused, transfused patients received fewer units of allogeneic blood. Patients who did not receive allogeneic transfusions had significantly lower postoperative infection rates (p<0.05) and length of stay (p<0.0001); multivariate analysis showed that allogeneic transfusion was an independent predictor of increased length of stay. Eighteen-month analysis indicates even greater reduction in allogeneic transfusion. The main measures of blood conservation employed were preoperative autologous donation and education, with recent increasing use of erythropoietin and the cell saver. These measures have been demonstrated to be very effective in avoiding allogeneic transfusion. CONCLUSIONS: The ONTraC have become leaders locally, nationally and internationally in blood conservation. The reduction in allogeneic transfusion associated with the implementation of the ONTraC program represents important savings in costs associated with blood components, hospital stay and work in transfusion laboratories and nursing units, as well as enhancing patient satisfaction and safety.     

Infection or suspected infection after hip replacement surgery with autologous or homologous blood transfusions

Homologous blood transfusions have been associated in both animals and humans with an increased risk of acute postoperative infectious complications. Eighty-four patients who underwent hip replacement surgery and were transfused with 2 or 3 units of blood were analyzed to determine whether those receiving homologous transfusions had different outcomes than those receiving autologous blood only. Only patients free of other risks for postoperative infection were studied. Those receiving homologous blood had a 32 percent (16/50) rate of proven or suspected infections, which was significantly higher than the 3 percent (1/34) rate in patients receiving autologous blood (p = 0.0029). Wound infections accounted for only a minority (6/17) of the proven or suspected infections, which suggests that nonsurgical factors contributed to these complications. The patients identified as being infected required significantly more antibiotic therapy (mean, 7.6 days) and lengthier hospital stays (mean, 15.5 days) than the patients who remained free of evidence of infection (means: 2.3 days of antibiotics and 12.3 days in the hospital) (p = 0.0001 for each variable). Other potential risk factors for infection, such as duration of surgical procedure, advanced patient age, amount of blood loss, type of anesthesia, surgeon performing the operation, use of a cemented versus porous-coat prosthesis, leukocytopenia, anemia, and underlying medical diagnosis, did not account for the differences in infection rates seen in those receiving homologous and autologous transfusions. These results confirm previous reports of an increased risk of postoperative infection in patients receiving homologous transfusions. Homologous transfusion may contribute to an increased risk of infection by immunologic modulation of the recipient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of storage time of red blood cell transfusions on the prognosis of coronary artery bypass graft patients

BACKGROUND: In different centers for cardiothoracic surgery throughout the world, different policies are followed concerning the maximum storage time of to-be-transfused red blood cells (RBCs). The aim in this study was to investigate the possible role of the storage time of RBC transfusions on the outcome of coronary artery bypass graft (CABG) surgery patients. STUDY DESIGN AND METHODS: In a single-center study, all patients who had undergone CABG surgery in the period 1993 until 1999 were identified. Only those patients who had received standard, allogeneic, buffy coat-depleted, unfiltered RBCs in saline-adenine-glucose-mannitol were entered in the analyses (n = 2732). Endpoints were 30-day survival, hospital stay, and intensive care unit (ICU) stay. Storage time of the perioperative RBC transfusions was analyzed in the following four ways: 1) mean storage time of all perioperative RBC transfusions; 2) storage time of the youngest RBC transfusion; 3) storage time of the oldest RBC transfusion; and 4) comparing outcome in patients receiving only RBCs with a storage time below the median storage of 18 days with patients receiving only RBCs with a storage time above the median. RESULTS: The univariate analyses showed a strong correlation between storage time and the endpoints survival and ICU stay, but also a correlation with an established risk factor such as the number of transfusions. The multivariate analyses showed no independent effect of storage time on survival or ICU stay. CONCLUSION: In these analyses, pertaining to 2732 CABG patients, no justification could be found for use of a particular maximum storage time for RBC transfusions in patients undergoing CABG surgery.     

Transfusion of buffy coat-depleted blood components and risk of postoperative infection in orthopedic patients

BACKGROUND: Allogeneic blood transfusions have been reported to increase susceptibility to postoperative infection, but the findings were inconclusive. This study was designed to investigate the effect of buffy coat-depleted allogeneic and autologous transfusion on postoperative infection in patients undergoing orthopedic surgery. STUDY DESIGN AND METHODS: Patients (n = 385) undergoing elective orthopedic surgery (primary and revision joint replacement, spinal, or pelvic surgery) were included in a prospective observational study of the incidence of postoperative infection between April and December 1996. Infection rates in patients who received allogeneic buffy coat-depleted blood transfusions were compared with those in patients who received no transfusion or only autologous (buffy coat-depleted) blood. RESULTS: Patients without exposure to allogeneic blood (no blood or only autologous blood) had an infection rate of 3.9 percent, as compared to a rate of 12.2 percent for those with exposure to allogeneic blood (allogeneic blood, autologous plus allogeneic blood) (odds ratio 3.442; 95% CI, 1.349-10.40; p = 0.006). Of the 385 study patients, 309 underwent primary hip or knee replacement surgery. In this homogeneous subgroup, the postoperative infection rate was 4.6 percent after no transfusion or autologous transfusion and 11.9 percent after allogeneic transfusion (odds ratio 2.827; 95% CI 1.059-8.799; p = 0.036). Multivariate regression analysis confirmed buffy coat-depleted allogeneic blood transfusion as an independent variable associated with high risk for postoperative infection. CONCLUSION: Buffy coat-depleted allogeneic blood transfusion increases the incidence of postoperative infection in patients undergoing uncontaminated orthopedic surgery.     

The effects of intraoperative blood salvage and induced hypotension on transfusion requirements during spinal surgical procedures

Spinal surgical procedures, such as placement of Harrington rods for correction of scoliosis, are associated with considerable perioperative blood loss and, hence, with the risks associated with homologous blood transfusions. To test the hypothesis that intraoperative autologous blood transfusions could decrease the amount of homologous blood needed in such operations, we conducted a two-part study: (1) a retrospective review of 142 patients in whom blood salvage was not used and (2) a prospective review of 28 patients who received autologous transfusions. Intraoperative autologous transfusion reduced the amount of homologous blood required by more than 50% (5.1 versus 2.0 units; P less than 0.001). The total amount of homologous blood required during the hospital stay was also significantly reduced by intraoperative autologous transfusion (6.0 versus 3.4 units; P less than 0.001). Induced hypotension in 81 of the 142 patients who did not receive autologous transfusions did not decrease the homologous blood transfusion requirements from those needed by the normotensive patients. We conclude that intraoperative autologous transfusion significantly reduces the need for homologous blood products in patients who undergo spinal surgical procedures. Induced hypotension, which did not affect transfusion requirements in our study, should be further evaluated in a blinded, prospective study.     

腰椎后路融合手术术中自体血回输对患者的影响

目的探讨术中自体血回输对腰椎后路融合术患者术后血红蛋白变化以及住院时间的影响。方法将2002年1月-2005年12月122例行腰椎后路内固定并接受输血的患者分为实验组(66例)和对照组(56例),实验组采用术中自体血回收,对照组使用异体输血。比较2组病例的术中失血量、术后引流量、异体输血量、术后血红蛋白值和影响住院时间的因素,以及输血后并发症发生率。结果实验组患者平均输入异体血170ml,对照组患者平均输入异体血615ml,2组间有显著性差异(P<0.05);2组术后各时间点的血红蛋白值无显著性差异(P>0.05);2组患者住院时间无显著性差异(P>0.05),内固定节段数目与住院时间有显著性差异(P<0.05);实验组1例患者术后出现菌血症,对照组中4例出现输血过敏反应。结论采用自体血回输技术对患者术后血红蛋白变化及住院时间无明显影响,可以防止脊柱融合手术时因输各种异体血引发的并发症发生。     

Cost-effectiveness of blood transfusion and white cell reduction in elective colorectal surgery

BACKGROUND: The use of white cell (WBC)-reduced blood in elective colorectal surgery appears to reduce the frequency of postoperative infection. The question to be addressed is whether the cost:benefit ratio justifies the recommendation that WBC-reduced blood should be used for all colorectal surgery. STUDY DESIGN AND METHODS: Patients admitted for elective colorectal surgery (n = 197) were randomly assigned to receive transfusion consisting of whole blood or WBC- reduced whole blood. Postoperative complications, postoperative stay, and hospital charges were compared. RESULTS: Forty-eight patients received WBC-reduced whole blood, 56 received unfiltered whole blood, and 93 received no transfusion. Postoperative infections were significantly higher (p < 0.001) in the group that received unfiltered whole blood. That group also had longer hospital stays: 17 days as compared to stays of 10 and 11 days for the group receiving no transfusion and the group receiving filtered whole blood transfusions, respectively (p < 0.01). The total hospital cost per patient receiving unfiltered whole blood was $12,347, as compared to $7,867 for those who received WBC-reduced whole blood and $7,030 for those who received no transfusion. CONCLUSION: The use of WBC-reduced whole blood transfusions in elective colorectal surgery significantly reduces the frequency of postoperative infection, the length of hospital stay, and the total hospital charges for patients needing blood transfusion.     

输血对脑膜瘤患者术后感染的影响观察

目的　了解输血对脑膜瘤患者术后感染的影响。方法　选择本院 2 5 7名脑膜瘤术中输血的患者进行临床观察 ,其中 132例输异体悬浮红细胞 ,12 5例输自体血 ,对两组病例术后感染率进行比较。结果　发现自体输血组患者术后感染率为 0 0 8% ,异体输血组患者术后感染率为 4 5 5 % ,两组术后感染率有显著性差异。结论　脑膜瘤患者术中异体输血者较自体输血者术后感染率高 ,其术后感染率与输异体血的量密切相关。     

A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery

Allogeneic blood transfusion has been implicated as an independent risk factor for postoperative bacterial infection in clinical and animal studies. The association among transfusion, quantitative immunologic factors, and infection was examined in 102 patients undergoing 109 spinal fusion procedures. In 60 procedures, patients received autologous blood only; in 24 procedures, they received at least 1 unit of allogeneic blood, and in 25 procedures, they received no transfusions. Twenty-two patients developed bacterial infections, in 8 cases while in hospital and in 14 cases after discharge. Univariate analysis revealed that patients who received any allogeneic blood and those who received no allogeneic blood differed significantly in the rate of hospital-acquired infection (20.8 vs. 3.5%), length of stay (12.3 vs. 9.7 days), days of fever greater than or equal to 38 degrees C (4.0 vs. 2.9), days on antibiotics (3.9 vs. 2.5), duration of surgery (309 vs. 231 min), blood loss (1343 vs. 887 mL), surgeon, and postoperative drop in natural killer (NK) cells (-174 vs. -42/microL). Multivariate logistic and linear regressions revealed that the number of allogeneic units transfused was the only significant predictor of in-hospital infection (p = 0.016) or days on antibiotics and length of stay. None of the clinical, surgical, or transfusion variables was significantly associated with posthospital infection, although a significantly greater drop in NK cells had occurred in patients who developed infection (p = 0.0035). These data strongly implicate allogeneic transfusion as a risk factor for in-hospital postoperative bacterial infection.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case-control study of the impact of WBC reduction on the cost of hospital care for patients undergoing coronary artery bypass graft surgery

BACKGROUND: WBC reduction of blood components may reduce the incidence of transfusion reactions. The cost of this intervention might be offset by a reduction in the incidence of postoperative infection, thereby reducing the length of hospital stay and thus the cost of care for patients receiving transfusion. Cedars-Sinai Medical Center provided WBC-reduced blood components to all patients for a period of 2 years, creating an opportunity to compare the incidence of postoperative infection, length of hospital stay, and total hospital costs for patients undergoing coronary artery bypass graft surgery, before, during, and after WBC reduction. STUDY DESIGN AND METHODS: Data were obtained by examining hospital records of patients who received transfusion and control patients who did not receive transfusion for the years 1991 (before WBC reduction), 1992 to 1993 (during WBC reduction), and 1994 (following discontinuation of WBC reduction). Comparisons were made by use of ANOVA following log or square root transformation of the data. RESULTS: Length of hospital stay for patients who received transfusion decreased over time. Mean hospital stays were 15.9, 14.1, and 12.1 days before, during, and after WBC reduction, respectively. A similar trend was seen in the patients who did not receive transfusion. There was no indication that WBC reduction functioned as an independent variable that was responsible for the observed decrease. The rate of postoperative infection stayed constant during WBC reduction and only dropped when WBC reduction was stopped. Mean hospital cost showed no significant change over time for either the transfusion group or the nontransfusion group. CONCLUSION: The cost of providing a totally WBC-reduced blood supply may not be offset by immediate savings related to decreased postoperative infections, reduced length of hospital stay, and cost of hospital care.     

Impact of perioperative transfusion in patients undergoing resection of colorectal cancer liver metastases: A population-based study

BACKGROUND Perioperative allogeneic blood transfusion is associated with poorer outcomes.AIM To identify the factors that were associated with perioperative transfusion and to examine the impact of perioperative transfusion in patients undergoing resection of colorectal cancer(CRC)liver metastases.METHODS The United States National Inpatient Sample(NIS)database was searched for patients with CRC who received surgery for liver metastasis.Linear and logistic regression analyses were performed.RESULTS A total of 2018 patients were included,and 480 had a perioperative transfusion.Emergency admission(adjusted odds ratio[aOR]=1.42;95%CI:1.07-1.87),hepatic lobectomy(aOR=1.76;95%CI:1.42-2.19),and chronic anemia(aOR=2.62;95%CI:2.04-3.35)were associated with increased chances of receiving a transfusion,but receiving surgery at a teaching hospital(aOR=0.75;95%CI:0.58-0.98)was associated with a decreased chance of receiving a transfusion.Receiving a perioperative transfusion was significantly associated with increased in-hospital mortality(aOR=3.38;95%CI:1.57-7.25),and increased overall postoperative complications(aOR=1.67;95%CI:1.31-2.13),as well as longer length of hospital stay CONCLUSION Patients with an emergency admission,hepatic lobectomy,chronic anemia,and who have surgery at a non-teaching hospital are more likely to receive a perioperative transfusion.Patients with CRC undergoing surgery for hepatic metastases who receive a perioperative transfusion are at a higher risk of inhospital mortality,postoperative complications,and longer length of hospital stay.     

术中血浆与红细胞输注比例对心脏外科手术患者预后的影响

目的 探讨术中血浆与红细胞输注比例（血浆/红细胞）对心脏外科手术术中输血患者预后的影响。方法 收集723例心脏外科手术术中输血患者的临床资料,根据输血量将其分为大量输血组（输血量≥8 U,282例）和非大量输血组（输血量< 8 U,441例）,2组再按血浆/红细胞进一步分为高比例组与低比例组2个亚组（高比例组：血浆/红...     

Autologous blood donation and subsequent blood use in patients undergoing total knee arthroplasty

Autologous blood donation is designed to avoid complications from allogeneic blood, leaving units of blood in the general blood supply. It is unclear how efficient these programmes are in accomplishing these goals. It is unclear if autologous donation provokes increased need for any transfusion following surgery and whether it can be avoided in low-risk surgeries. Of 430 patients undergoing unilateral primary knee replacement arthroplasty over 12 months in our hospital, 309 had autologous donations and 121 did not. Of the 121 patients who did not donate, 36% completed surgery without transfusion, whereas only 17% of those who had autologous donations did so (P < 0.05). Age less than 65 years, higher baseline and postoperative haemoglobin levels were associated with lower transfusion rates. Patients who had autologous donations were approximately four times more likely to be transfused. As the number of autologous units donated increased, transfusions following surgery increased. Autologous donation did reduce allogeneic blood transfusions. Therefore, autologous blood donation for unilateral total knee arthroplasty is associated with overall increased transfusion rates, but with reduced need for allogeneic blood, independent of other clinical factors associated with transfusion. Therefore, there is need for reconsideration of these programmes relative to specific surgeries.     

Plasma fibrinogen level, bleeding, and transfusion after on-pump coronary artery bypass grafting surgery: a prospective observational study

BACKGROUND: Early identification of patients with increased risk of excessive bleeding and transfusion after cardiac surgery offers the possibility to initiate countermeasures. Fibrinogen is a key protein in the coagulation cascade and thus a potential biomarker for bleeding. We investigated the relationship between preoperative fibrinogen plasma concentration and postoperative bleeding and transfusion after coronary artery bypass grafting (CABG). STUDY DESIGN AND METHODS: A total of 170 patients (mean age, 67 ± 9 years; 75% men) undergoing isolated CABG were included in a prospective observational study. Patient variables (age, sex, operation time, anticoagulation therapy), preoperative laboratory variables (platelet [PLT] count, activated partial thromboplastin time, prothrombin time, and fibrinogen), postoperative bleeding volume, and transfusions during hospital stay were registered. Independent predictors of bleeding volume and transfusion were identified with multiple regression models. RESULTS: Postoperative bleeding volume correlated univariately with preoperative fibrinogen concentration (r = ?0.53, p < 0.001) and PLT count (r = ?0.26, p = 0.001) but only preoperative fibrinogen concentration was an independent predictor of postoperative bleeding volume. Twenty‐nine of the 170 patients (17%) received transfusions with blood products. Independent predictors of transfusion were preoperative fibrinogen concentration (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1‐3.7 per 1‐unit decrease; p = 0.027), female sex (OR, 5.0; 95% CI, 1.8‐14.7; p = 0.002), and aortic cross‐clamp time (OR, 1.03; 95% CI, 1.01‐1.06 per minute; p = 0.013). CONCLUSION: The results indicate that preoperative fibrinogen concentration (even within the normal range) is a limiting factor for postoperative hemostasis. Preoperative measurement of fibrinogen concentration provides information about bleeding volume and transfusion requirements after CABG.     

Simplified enrollment for autologous transfusion: automatic referral of presurgical patients for assessment for autologous blood collections.

We implemented a pilot program at our institution for automatic referral of patients for presurgical assessment for preoperative and intraoperative collection of autologous blood. Although patients and clinicians support the use of autologous transfusion, often a request for collection of autologous blood is not initiated. During 11 months, 269 patients (82%) of three orthopedic surgeons entered the program, and 218 underwent operation and were dismissed from the hospital. A total of 940 units of autologous blood (675 preoperatively and 265 intraoperatively) was collected from these 218 patients, and 84% of the units were transfused. Throughout hospitalization, 86% of the patients received only autologous blood, whereas 14% received various proportions of homologous and autologous blood. In contrast, only 26% of a concomitant control group of 220 consecutive orthopedic surgical patients not participating in the automatic-referral program received only autologous blood. Thus, the automatic-referral program increased the percentage of elective orthopedic surgical patients who received only autologous blood from 26% to 86% (P less than 0.001). This study also showed that the same amount of blood was used for autologous transfusions as was routinely used for homologous transfusions in similar cases. The automatic-referral system was convenient for physicians and patients and offered the benefits of reduction of transfusion-associated risks and amelioration of patient anxieties.     

Endovascular stent-graft placement versus conventional open surgery in infrarenal aortic aneurysm: a prospective study on acute phase response and clinical outcome.

BACKGROUND: For the treatment of aortic aneurysm, stent-graft implantation is an alternative method to open surgery. There is no study comparing both methods with regard to endotoxaemia, the acute phase cascade, and clinical outcome. METHODS: In this prospective study, we enrolled 40 patients (34 males, 6 females; mean age 72.1+/-7.5 [58-92] years) with infrarenal abdominal aortic aneurysm who underwent aortic surgery. Comparable groups of patients were treated with open (n=20) or endovascular (n=20) stent-graft implantation. To characterize the inflammatory response, plasma levels of endotoxin, endotoxin-neutralizing capacity (ENC), interleukin-6 (IL-6), C-reactive protein (CRP), and white blood cell count were determined. In all patients, measurements were performed on admission, skin suture, 4 h and from the first to fifth postoperative day. As parameters for the clinical outcome, we assessed daily temperature, lung function, pain, duration of postoperative hospital stay, and morbidity. Wilcoxon rank test was used for statistical analysis. RESULTS: In both groups, a significant increase of endotoxin plasma levels and a decrease of ENC was found already after skin incision. IL-6 levels peaked 4 h postoperatively in both groups, whereas CRP rose at the first postoperative day, reaching a maximum at day 2. Conventionally operated patients had significantly higher plasma levels of endotoxin, IL-6, and CRP and lower ENC during and after surgery than patients with stent-graft implantation. Moreover, patients with endovascular stent grafting had significant less postoperative pain, less restriction of total vital capacity, a shorter hospital stay, and a lower morbidity. CONCLUSIONS: Endovascular stent grafting of infrarenal aortic aneurysm seems to be superior not only in terms of the inflammatory response but also in overall clinical outcome.     

Efficacy of cell saver in reducing homologous blood transfusions during OPCAB surgery: a prospective randomized trial

Despite the refinements in surgical technique, rates of homologous blood transfusion (HBT) in cardiac surgery remain high. The adverse effects of blood transfusion are well documented. Retransfusion of shed mediastinal blood reduces the requirement for HBTs during conventional coronary artery bypass grafting. However, some studies have found that autotransfusion leads to bleeding diathesis and paradoxical increase in blood transfusions. Through this prospective randomized trial, we have studied the safety and efficacy of this modality in patients undergoing off-pump coronary artery bypass grafting (OPCAB). Fifty patients enrolled in the study and 49 fulfilled the study criteria. They were randomly divided into group C (cell saver) and group N (non-cell saver). Whereas the cell saver group received processed shed autologous blood and homologous blood if necessary, the non-saver group was transfused homologous blood only. The threshold for transfusion was haemoglobin of 9 g dL(-1) in both the groups. The cell saver group required significantly less number of HBTs (1.6 +/- 1.2 vs. 2.4 +/- 1.3 units). The incidence of re-exploration was zero in both the groups. The mean mediastinal drainage in both the groups was not significantly different (355 +/- 196 vs. 316 +/- 119.8 mL). The number of patients requiring any blood transfusion however was very high. All the patients in the non-saver group and 20 (83%) of the patients in the saver group received homologous blood. During OPCAB surgery, the use of cell saver reduced the requirement for HBT. Its use is not associated with any clinically significant bleeding diathesis.