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