Comparison of the effects of a cell saver and low-dose aprotinin on blood loss and homologous blood usage in patients undergoing valve surgery

Tempe, Deepak K; Banerjee, Amit; Virmani, Sanjula; Mehta, Navneet; Panwar, Sunil; Tomar, A. S.; Ghambeer, Daljeet; Nigam, M

doi:10.1053/jcan.2001.23282

Cited by 23 publications

(11 citation statements)

References 34 publications

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“…Two other studies reported that employment of cell saver was not associated with any adverse impact on coagulation parameters or increased blood product transfusion rates. 33,34 However, the extensive use of cell salvage systems to process cardiotomy blood may lead to a critical loss of coagulation factors and platelets, resulting in a bleeding diathesis. 35 The findings of our study are in agreement with the latter statement.…”

Section: Djaiani Et Al Cognitive Decline and Coronary Bypass Surgerymentioning

confidence: 99%

Continuous-Flow Cell Saver Reduces Cognitive Decline in Elderly Patients After Coronary Bypass Surgery

Djaiani

Fedorko²,

Borger³

et al. 2007

Circulation

135

110

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Background-Cerebral microembolization during cardiopulmonary bypass may lead to cognitive decline after cardiac surgery. Transfusion of the unprocessed shed blood (major source of lipid microparticulates) into the patient during cardiopulmonary bypass is common practice to reduce blood loss and blood transfusion. Processing of shed blood with cell saver before transfusion may limit cerebral microembolization and reduce cognitive decline after surgery. Methods and Results-A total of 226 elderly patients were randomly allocated to either cell saver or control groups.Anesthesia and surgical management were standardized. Epiaortic scanning of the proximal thoracic aorta was performed in all patients. Transcranial Doppler was used to measure cerebral embolic rates. Standardized neuropsychological testing was conducted 1 week before and 6 weeks after surgery. The raw scores for each test were converted to Z scores, and then a combined Z score of 10 main variables was calculated for both study groups. The primary analysis was based on dichotomous composite cognitive outcome with a 1-SD rule. Cognitive dysfunction was present in 6% (95% confidence interval, 1.3% to 10.7%) of patients in the cell saver group and 15% (95% confidence interval, 8% to 22%) of patients in the control group 6 weeks after surgery (Pϭ0.038). The severity of aortic atheroma and cerebral embolic count were similar between the 2 groups. Conclusions-The present report demonstrates that processing of shed blood with cell saver results in clinically significant reduction in postoperative cognitive dysfunction after cardiac surgery. These findings emphasize the clinical importance of lipid embolization in contributing to postoperative cognitive decline in patients exposed to cardiopulmonary bypass.

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Section: Djaiani Et Al Cognitive Decline and Coronary Bypass Surgerymentioning

confidence: 99%

Continuous-Flow Cell Saver Reduces Cognitive Decline in Elderly Patients After Coronary Bypass Surgery

Djaiani

Fedorko²,

Borger³

et al. 2007

Circulation

135

110

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“…16 Although studies in adults indicate that this agent can decrease blood loss and transfusion requirements in spinal operations, none of these studies used a randomized, blinded study design to assess the efficacy of aprotinin. [17][18][19] We used this type of study design to evaluate the effectiveness of aprotinin in pediatric patients who were undergoing a long segment posterior spinal fusion. …”

mentioning

confidence: 99%

Aprotinin Reduces Blood Loss During Spinal Surgery in Children

Cole¹,

Murray²,

Snider³

et al. 2003

Spine

102

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“…Autologous blood cell salvage is used routinely in many parts of the world in cardiac [ASA Task Force on Perioperative Blood Transfusion and Adjuvant Therapies 2006] and other high-risk operations [Goodnough 2003]. We studied 3 reviews [Goodnough 2003; ASA Task Force on Perioperative Blood Transfusion and Adjuvant Therapies 2006; Ferraris 2007] and 17 clinical trials [Moran 1978;Thurer 1979;Cordell 1981;Winton 1982;Keeling 1983;Mayer 1985;Dietrich 1989;Hall 1990;Merville 1991;Despotis 1996;Tempe 1996;Lee 1997;Gray 2001;Tempe 2001;Daane 2003;Svenmarker 2003; (Table 3). Most of the trials are RCTs [Moran 1978;Thurer 1979;Mayer 1985;Dietrich 1989;Merville 1991;Tempe 1996;Tempe 2001;Daane 2003;Svenmarker 2003;.…”

Section: Red Cell Savingmentioning

confidence: 99%

“…Today, cell saving devices can process quickly even small amounts of blood, require small priming volumes, continuously return high quality blood during and after surgery, and can collect blood not only during heparinization, but also when there is no heparin effect (eg, during internal mammary artery preparation). Several reports document the safety of the cell saver and support its routine use in cardiac surgery as a means to reduce blood transfusion [Moran 1978;Cordell 1981;Winton 1982;Keeling 1983;Mayer 1985;Hall 1990;Lee 1997;Tempe 2001], and intraoperative autologous blood donation combined with cell saver use decreases transfusion requirements in small-size patients (mean body weight of 45 kg) [Tempe 1996]. In a recent RCT, patients scheduled for CABG were randomized to autotransfusion (receiving autotransfused washed blood from intraoperative cell salvage and postoperative mediastinal fl uid cell salvage, n = 98), or control (receiving stored homologous blood only, n = 102).…”

Section: Red Cell Savingmentioning

confidence: 99%

Management of Intraoperative Fluid Balance and Blood Conservation Techniques in Adult Cardiac Surgery

Vretzakis¹,

Kleitsaki²,

Αρέθα³

et al. 2011

HSF

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Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. This report also identified several pre- and intraoperative interventions that may help reduce blood transfusions, including off-pump procedures, preoperative autologous blood donation, normovolemic hemodilution, and routine cell saver use.A multimodal approach to blood conservation, with high-risk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization.This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery.

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Comparison of the effects of a cell saver and low-dose aprotinin on blood loss and homologous blood usage in patients undergoing valve surgery

Cited by 23 publications

References 34 publications

Continuous-Flow Cell Saver Reduces Cognitive Decline in Elderly Patients After Coronary Bypass Surgery

Continuous-Flow Cell Saver Reduces Cognitive Decline in Elderly Patients After Coronary Bypass Surgery

Aprotinin Reduces Blood Loss During Spinal Surgery in Children

Management of Intraoperative Fluid Balance and Blood Conservation Techniques in Adult Cardiac Surgery

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