Title: Effectiveness of low volume acute normovolemic hemodilution in patients undergoing off pump coronary artery bypass grafting surgery
Authors: Premraj Nagarwal, Gaurav Goyal, Jeevraj Singh Rajawat, Saurabh Gupta
DOI: https://dx.doi.org/10.18535/jmscr/v7i8.117
Abstract
Background: The objective of this study was to evaluate the effectiveness of low volume acute normovolemic hemodilution (LVANH) in patients undergoing primary elective off pump coronary artery bypass graft (OPCAB) surgery.
Methods: Sixty patients undergoing primary elective OPCAB surgery were prospectively randomized into two groups: Group LVANH (n=30) and Group C (n=30) as control. Autologous blood was removed (< 4 ml/ kg but more than 200 ml ) of estimated blood volume in patients with hemoglobin (Hb) >12g% to keep hematocrit more than 30% after acute normovolumic hemodilutuion for subsequent re-transfusion after protamine administration from group LVANH, while no blood was withdrawn from control group. The autologous blood withdrawn was replaced simultaneously with an equal volume of hydroxyl-ethyl starch solution in group LVANH patients only. Allogenic blood was transfused in both the groups when Hb was ≤8.5g %. Total post operative drain and requirement of postoperative allogenic blood transfusion along with any adverse events were evaluated.
Results: The two groups were comparable in regards of demographic data, type of surgical procedures performed, duration of surgery. Both groups have comparable hemaocrit and ACT levels at the time of shifting to post operative cardiac surgery unit without any added ischemic or hemodynamic intraoperative events. During first and fourth hour of recovery period, amount of blood drainage is significantly reduced in LVANH group but after twenty four hours amount of total blood drain is comparable. Perioperative blood transfusion requirements were also not statistically different. No patient in any of the groups suffered major adverse cardiac event. Patients were extubated, shifted out of intensive care unit and discharged home with comparable time periods.
Conclusion: We conclude that low volume autologous blood transfusion procedure is safe and can be done without any added risk to selected patients those are posted for off pump cardiac surgery. This method of blood salvage may have importance during first four hours of surgery but had no advantage after that period on perioperative blood loss and transfusion requirements.
Keywords: Low volume acute normovolemic hemodilution, off pump coronary artery bypass graft surgery.
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