Reduction of hemodilution in small adults undergoing open heart surgery: A prospective, randomized trial

Federico Pappalardo, C. Corno, A. Franco, G. Giardina, A. M. Scandroglio, G. Landoni, G. Crescenzi, A. Zangrillo

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background. Given that there is an association between the degree of hemodilution during cardiopulmonary bypass (CPB) and postoperative complications, patients-outcome might be improved if the nadir hematocrit concentration is kept within an optimal range. Smaller patients are more likely to have a low hematocrit during CPB: this phenomenon may be related, at least partially, to the extreme hemodilution induced by a large fixed CPB priming volume. Methods. Forty patients with a body surface area (BSA) <1.7 m2 undergoing open heart operations were randomized to either standard CPB with full prime volume (control group) or reduced prime extracorporeal circuit and vacuum-assisted venous drainage (VAVD) (study group). Results. There were no significant differences between the groups with respect to baseline characteristics, body surface area, hematologic profile and operative data. Clinical outcomes were similar. Nadir hematocrit and hemoglobin on bypass were significantly lower in the control group (22 ± 2.3 vs 24 ± 2.5%, p <0.02 and 7.4 ± 0.7 vs 8 ± 0.9 g/dl, p <0.04, respectively). Postoperative chest tube drainage was significantly higher in the control group (272 ± 253 vs 139 ± 84 ml, p <0.04). There was no difference in blood transfusion in the two groups (0.5 ± 1.14 v 1.0 ± 1.77 units of packed red blood cells (PRBC), p = 0.29). Conclusions. Lowering CPB priming volume by means of using a small oxygenator and vacuum-assisted venous drainage (VAVD) resulted in a significant decrease of intraoperative hemodilution. This technique should be strongly considered for patients with a small BSA (<1.7 m2) undergoing open heart surgery.

Original languageEnglish
Pages (from-to)317-322
Number of pages6
JournalPerfusion
Volume22
Issue number5
DOIs
Publication statusPublished - 2007

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Hemodilution
Cardiopulmonary Bypass
Surgery
surgery
Thoracic Surgery
Drainage
Body Surface Area
Hematocrit
Blood
Oxygenators
Vacuum
Group
Hemoglobin
Control Groups
Chest Tubes
Cells
Association reactions
study group
Networks (circuits)
Blood Transfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Reduction of hemodilution in small adults undergoing open heart surgery : A prospective, randomized trial. / Pappalardo, Federico; Corno, C.; Franco, A.; Giardina, G.; Scandroglio, A. M.; Landoni, G.; Crescenzi, G.; Zangrillo, A.

In: Perfusion, Vol. 22, No. 5, 2007, p. 317-322.

Research output: Contribution to journalArticle

Pappalardo, Federico ; Corno, C. ; Franco, A. ; Giardina, G. ; Scandroglio, A. M. ; Landoni, G. ; Crescenzi, G. ; Zangrillo, A. / Reduction of hemodilution in small adults undergoing open heart surgery : A prospective, randomized trial. In: Perfusion. 2007 ; Vol. 22, No. 5. pp. 317-322.
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AU - Scandroglio, A. M.

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AU - Crescenzi, G.

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N2 - Background. Given that there is an association between the degree of hemodilution during cardiopulmonary bypass (CPB) and postoperative complications, patients-outcome might be improved if the nadir hematocrit concentration is kept within an optimal range. Smaller patients are more likely to have a low hematocrit during CPB: this phenomenon may be related, at least partially, to the extreme hemodilution induced by a large fixed CPB priming volume. Methods. Forty patients with a body surface area (BSA) <1.7 m2 undergoing open heart operations were randomized to either standard CPB with full prime volume (control group) or reduced prime extracorporeal circuit and vacuum-assisted venous drainage (VAVD) (study group). Results. There were no significant differences between the groups with respect to baseline characteristics, body surface area, hematologic profile and operative data. Clinical outcomes were similar. Nadir hematocrit and hemoglobin on bypass were significantly lower in the control group (22 ± 2.3 vs 24 ± 2.5%, p <0.02 and 7.4 ± 0.7 vs 8 ± 0.9 g/dl, p <0.04, respectively). Postoperative chest tube drainage was significantly higher in the control group (272 ± 253 vs 139 ± 84 ml, p <0.04). There was no difference in blood transfusion in the two groups (0.5 ± 1.14 v 1.0 ± 1.77 units of packed red blood cells (PRBC), p = 0.29). Conclusions. Lowering CPB priming volume by means of using a small oxygenator and vacuum-assisted venous drainage (VAVD) resulted in a significant decrease of intraoperative hemodilution. This technique should be strongly considered for patients with a small BSA (<1.7 m2) undergoing open heart surgery.

AB - Background. Given that there is an association between the degree of hemodilution during cardiopulmonary bypass (CPB) and postoperative complications, patients-outcome might be improved if the nadir hematocrit concentration is kept within an optimal range. Smaller patients are more likely to have a low hematocrit during CPB: this phenomenon may be related, at least partially, to the extreme hemodilution induced by a large fixed CPB priming volume. Methods. Forty patients with a body surface area (BSA) <1.7 m2 undergoing open heart operations were randomized to either standard CPB with full prime volume (control group) or reduced prime extracorporeal circuit and vacuum-assisted venous drainage (VAVD) (study group). Results. There were no significant differences between the groups with respect to baseline characteristics, body surface area, hematologic profile and operative data. Clinical outcomes were similar. Nadir hematocrit and hemoglobin on bypass were significantly lower in the control group (22 ± 2.3 vs 24 ± 2.5%, p <0.02 and 7.4 ± 0.7 vs 8 ± 0.9 g/dl, p <0.04, respectively). Postoperative chest tube drainage was significantly higher in the control group (272 ± 253 vs 139 ± 84 ml, p <0.04). There was no difference in blood transfusion in the two groups (0.5 ± 1.14 v 1.0 ± 1.77 units of packed red blood cells (PRBC), p = 0.29). Conclusions. Lowering CPB priming volume by means of using a small oxygenator and vacuum-assisted venous drainage (VAVD) resulted in a significant decrease of intraoperative hemodilution. This technique should be strongly considered for patients with a small BSA (<1.7 m2) undergoing open heart surgery.

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