ORIGINAL ARTICLE
Haematic antegrade repriming to enhance recovery after cardiac surgery from the perfusionist side
Juan Blanco-Morillo ( ECCP , PhD ) 1
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, Diego Salmerón Martínez ( PhD ) 2 , 3 , 4 ,* |
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Jose M . Arribas-Leal ( PhD , MD ) 1
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, Piero Farina ( PhD , MD ) 5 , Luc Puis ( ECC ) 6
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Angel J . Sornichero-Caballero ( RN ) 1 , and Sergio J . Cánovas-López ( PhD , MD ) 1
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1 Cardiac Surgery Department , Virgen de la Arrixaca University Hospital , 30120 Murcia , Spain
2 Department of Health and Social Sciences , Murcia University , 30120 Murcia , Spain
3 IMIB-Arrixaca , 30120 Murcia , Spain
4 CIBER Epidemiology and Public Health CIBERESP , 28029 Madrid , Spain
5 Cardiac Surgery Department , Agostino Gemelli University Policlinic , 00168 Rome , Italy
6 Department of Extra Corporeal Circulation , UZ Gasthuisberg , KU Leuven , 3000 Leuven , Belgium
Received 24 July 2022 , Accepted 11 January 2023
Abstract – Background : New era of cardiac surgery aims to provide an enhanced postoperative recovery through the implementation of every step of the process . Thus , perfusion strategy should adopt evidence-based measures to reduce the impact of cardiopulmonary bypass ( CPB ). Hematic Antegrade Repriming ( HAR ) provides a standardized procedure combining several measures to reduce haemodilutional priming to 300 mL . Once the safety of the procedure in terms of embolic release has been proven , the evaluation of its beneficial effects in terms of transfusion and ICU stay should be assessed to determine if could be considered for inclusion in Enhanced Recovery After Cardiac Surgery ( ERACS ) programs . Methods : Two retrospective and non-randomized cohorts of high-risk patients , with similar characteristics , were assessed with a propensity score matching model . The treatment group ( HG ) ( n = 225 ) received the HAR . A historical cohort , exposed to conventional priming with 1350 mL of crystalloid confirmed the control group ( CG ) ( n = 210 ). Results : Exposure to any transfusion was lower in treated ( 66.75 % vs . 6.88 %, p < 0.01 ). Prolonged mechanical ventilation (> 10 h ) ( 26.51 % vs . 12.62 %; p < 0.01 ) and extended ICU stay (> 2 d ) ( 47.47 % vs . 31.19 %; p < 0.01 ) were fewer for treated . HAR did not increase early morbidity and mortality . Related savings varied from 581 to 2741.94 $/ patient , depending on if direct or global expenses were considered . Discussion : By reducing the gaseous and crystalloid emboli during CPB initiation , HAR seems to have a beneficial impact on recovery and reduces the overall transfusion until discharge , leading to significant cost savings per process . Due to the preliminary and retrospective nature of the research and its limitations , our findings should be validated by future prospective and randomized studies .
Key words : Cardiopulmonary Bypass , Hematic antegrade repriming , Minimized extracorporeal circuits , Haemodilution , blood conservation , Enhanced recovery after surgery .
Introduction
The new era of cardiac surgery has changed the paradigm of obtaining an acceptable survival rate to the adoption of Enhanced Recovery After Cardiac Surgery ( ERACS ) programs to reinforce every step of the perioperative procedure to augment the efficiency of cardiac surgery processes . Thus , the recommended intraoperative interventions are mainly oriented to maintaining temperature , glycemia , and oxygenation within a physiological range [ 1 – 3 ].
* Corresponding author : dsm @ um . es
Due to the relevant contribution of the cardiopulmonary bypass ( CPB ) in this regard , the perfusionist approach in ERACS should be focused on the adoption of evidence-proven strategies to reduce the impact of CPB in terms of homeostasis , blood product requirements ( BPR ), and inflammatory response .
Minimally invasive extracorporeal circuits ( MiECC ) and repriming techniques like retrograde autologous priming ( RAP ) have been strongly recommended for blood-saving [ 1 , 4 , 5 ]. However , methodological weakness in current studies and heterogeneity between authors in the application of both is a matter of concern [ 6 – 11 ] about its beneficial effect in terms of the whole process .
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