IN SURGERY OF THE ANEURYSMS OF THE THORACIC AORTA
B.Čalija, B. Đukanović, G. Milosavljević, D. Radojević, M.
Jović, B. Radomir, M. Kocarev, R. Huskić, S. Nastašić and
Center, Dedinje Cardiovascular Institute, Belgrade, Yugoslavia
Background: Blood loss is a major problem
in aortic surgery. It is heavily influenced by the degree of the
damage to the thoracal aorta, cross-clamping time, dilution, deep
hypothermia, and preoperative anemia. In this observational study
we sought to investigate possibilities for intraoperative blood
recuperation during surgery of the aneurysms of the thoracal aorta.
Methods: Because of the complexity
of the operation we regularly used aprotinim and machine for intraoperative
blood recuperation. However, when haematological and biochemical
criteria were met, we used preoperative collection of one or more
( up to five) units of autologuos blood (acute normovolemic hemodilution).
Cristaloids and colloids replaced circulating volume. Blood products,
such as red blood cells, plasma and concentrated platelets, were
prepared out of collected blood. At the of the surgery, blood
from operative field and machine for extracorporal circulation
was collected and processed to remove heparin, nonfunctional cells
and proteins. Viable red blood cells were washed with isotonic
saline, and transfused back to patient.
Results: During the last four years, a total of 114 patients
with aneurysm of the proximal aorta were operated in our institutions.
In 71 patient deep hypothermic circulatory arrest (14-18°C) was
used because of the complexity of the operation. Transfusion was
necessary in 81 patients, and the average consumption of blood
product per patient was 3 (1-13) units of red blood cells, 5 units
(3-10) of fresh frozen plasma and 5 units (2-10) of platelets.
Preoperatively, a total of 204 units of blood was collected from
78 patients using ANH. Intraoperatively, a total of 318 units
of washed red blood cells was recuperated, with an average of
3 units per patient. Alogenous blood products were not administered
in 34 patients (30%). Postoperative mortality was 16%. Conclusions:
In the setting of aortic surgery for the aneurysms of the thoracal
aorta, the use of alogenous blood and blood products can be reduced
by use of their autologuos counterparts, collected by means of
ANH and interoperative blood recuperation