A New PRECiSe (Priming Reduced Extracorporeal Circulation Setup) Minimizes the Need for Blood Transfusions: First Clinical Results in Coronary Artery Bypass Grafting

Abstract

Hemodilution by the crystalloid priming volume of standard heart-lung machines in cardiac surgery is associated with impaired organ function and increased blood transfusion requirements. The aim of this study was to evaluate the effect of the use of the newly developed priming reduced extracorporeal circulation setup (PRECiSe) on perioperative hemodilution and transfusion requirements. In a matched prospective study, 40 patients who underwent operations with the PRECiSe in elective primary coronary artery bypass surgery were compared with 40 patients who underwent operations with the standard heart-lung machine. A significant reduction in final priming volume resulted in a significantly reduced degree of hemodilution and transfusion requirements during and after extracorporeal circulation. In the PRECiSe group, only 10% of the patients needed transfusions during their hospital stay, whereas 35% of the patients in the control group required any transfusion (P < .05). The average transfusion per patient was 0.16 units in the PRECiSe group and 1.25 units in the control group (P < .05). The PRECiSe was demonstrated to be safe and effective in coronary artery bypass surgery with respect to transfusion requirements and hemodilution, as well as with regard to patient safety, as represented by perioperative myocardial performance.

Meta-analysis of randomised trials comparing the effectiveness of miniaturised versus conventional cardiopulmonary bypass in adult cardiac surgery

“…Seven studies have been excluded from the meta-analysis because of the non-random design,4 – 10 four because of retrospective nature,11 – 14 six because of lack of relevant clinical outcome end-points15 – 20 and three because of duplicate data 21 – 23…”

Advances in Perfusion Techniques

“…28,29 Several reports have illustrated that a reduction in surface area priming volume and matching the CPB circuit to the size of the patient reduces the frequency of low HCT values and subsequently reduces the incidence of allogeneic blood transfusions. [30][31][32][33] In addition to efforts to maintain HCT, it is important to appreciate the concept of oxygen delivery (DO 2 ) during CPB for minimally invasive procedures. DO 2 is dependent on the combination of HCT and CPB flow rates.…”

Hemotherapy in Cardiac Surgery

“…Its milestones have included a refinement of surgical methods, a better understanding of bleeding pathology related to extracorporeal circulation and an introduction of coagulation monitoring during surgery, using point-of-care testing [1,2,3,4,5]. A significant advancement in extracorporeal circulation came with the development of less aggressive, more biocompatible and miniature-circuit systems [6,7]. As a result, allogeneic blood transfusion is currently not needed in over 50% of all surgical procedures and in almost 100 % of coronary heart operations [8,9].…”