Abstract
The use of blood products in 1480 consecutive cases of adult cardiac surgical procedures over a period of 15 mth was studied retrospectively using the database of the Department of Anaesthesia of the Institut de Cardiologie de Montreal. Use of blood products was compared in patients having (1) coronary artery bypass grafting, (2) valvular surgery, (3) or a combination of 1 and 2. First operations were compared with reoperations. Overall, the use of homologous blood products was greatest in patients of Group 3, intermediate in patients of Group 2, and smallest in patients of Group I. Reoperations were associated with an increase in inlraoperative transfusion of packed red blood cells, but postoperative chest drainage was similar to first operations. When all blood products (packed red blood cells, fresh frozen plasma and platelets were taken into consideration, patients undergoing primary CABG or valve surgery were the least exposed to homologous blood donors (five and six units transfused respectively). Repeat CABG was associated with an intermediate exposure to homologous blood products (eight units). Finally, primary and repeat combined procedures, and repeat valve surgery were associated with the greatest exposure to foreign blood products (10, 13 and 10 units respectively). The data presented in this study provide a rational basis for stratification of procedures according to the expected use of blood products, particularly in view of future studies which may be planned to examine the efficiency of blood conservation strategies.
Résumé
Cette étude rétrospective rapporte l’utilisation des produits sanguins en chirurgie cardiaque de l’adulte à l’Institut de Cardiologie de Montréal chez 1480 patients opérés sous circulation extracorporelle entre novembre 1988 et avril 1990. Les patients out été regroupés selon l’intervention subie: 1) la revascularisation myocardique, 2) la chirurgie valvulaire, 3) une combinaison de 1 et de 2. Nous avons égalemenl comparé les interventions de premiere intention avec les réinterventions. A u total, les besoins en produits sanguins homologues out été les plus considérables chez les patients du groupe 3, intermédiaires chez les patients du groupe 2, et les plus faibles chez les patients du groupe I. Les réinterventions out été associées à une augmentation des transfusions de culots globulaires durant la chirurgie, mais non à des pertes sanguines postopératoires accrues. Lorsque tous les produits sanguins sont pris en consideration (culots globulaires, plasma, plaquettes), l’exposition (en nombre dunités) aux produits sanguins homologues était la plus faible chez les patients subissant une premiere chirurgie de revascularisation (cinq unités) on une chirurgie valvulaire de premiere intention (six unités). Dans la réintervention pour revascularisation myocardique Vexposition était intermédiaire (huit unités), alors qu’elle était la plus forte dans la chirurgie combinée, qu’elle soit primaire ou de réintervention (10 ou 13 unités). Les données présentées dans cette étude permettent de stratifier les chirurgies en fonction des besoins transfusionnels prévus et devraient nous guider dans la gestion des technologies visant à diminuer les pertes sanguines el l’exposition aux produits sanguins homologues en chirurgie cardiaque de l’adulte.
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Hardy, JF., Perrault, J., Tremblay, N. et al. The stratification of cardiac surgical procedures according to use of blood products: a retrospective analysis of 1480 cases. Can J Anaesth 38, 511–517 (1991). https://doi.org/10.1007/BF03007591
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DOI: https://doi.org/10.1007/BF03007591