CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
AFRICA
121
Comparison of results of autologous versus homologous
blood transfusion in open-heart surgery
BILGEHAN SAVAS OZ, GOKHAN ARSLAN, ERKAN KAYA, CELALETTIN GUNAY, FARUK CINGOZ,
MEHMET ARSLAN
Abstract
Background:
The aim of this study was to determine a meth-
od to decrease the use of homologous blood during open-
heart surgery using a simple blood-conservation protocol.
We removed autologous blood from the patient before bypass
and used isovolumetric substitution.We present the results of
this protocol on morbidity and mortality of surgery patients
from two distinct time periods.
Methods:
Patients from the two surgical phases were enrolled
in this retrospective study in order to compare the outcomes
using autologous or homologous blood in open-heart surgery.
A total of 323 patients were included in the study. The autolo-
gous transfusion group (group 1) comprised 163 patients and
the homologous transfusion group (group 2) 160 patients.
In group 1, autologous bloods were prepared via a central
venous catheter that was inserted into the right internal
jugular vein in all patients, using the isovolumetric replace-
ment technique. The primary outcome was postoperative
in-hospital mortality and mortality at 30 days. Secondary
outcomes included the length of stay in hospital and in
intensive care unit (ICU), time for extubation, re-intubations,
pulmonary infections, pneumothorax, pleural effusions, atri-
al fibrillation, other arrhythmias, renal disease, allergic reac-
tions, mediastinitis and sternal dehiscence, need for inotropic
support, and low cardiac-output syndrome (LCOS).
Results:
The mean ages of patients in groups 1 and 2 were
64.2
±
10.3 and 61.5
±
11.6 years, respectively. Thirty-eight
of the patients in group 1 and 30 in group 2 were female.
There was no in-hospital or 30-day mortality in either group.
The mean extubation time, and ICU and hospital stays were
significantly shorter in group 1. Furthermore, postoperative
drainage amounts were less in group 1. There were signifi-
cantly fewer patients with postoperative pulmonary compli-
cations, pneumonia, atrial fibrillation and renal disease.
The number of patients who needed postoperative inotropic
support and those with low cardiac output was also signifi-
cantly less in group 1.
Conclusion:
Autologous blood transfusion is a safe and effec-
tive method in carefully selected patients undergoing cardiac
surgery. It not only prevents transfusion-related co-morbidi-
ties and complications but also enables early extubation time
and shorter ICU and hospital stay. Furthermore, it reduces
the cost of surgery.
Keywords:
autologous blood usage, open-heart surgery, post-
operative morbidity
Submitted 31/1/12, accepted 19/3/13
Published online 4/4/13
Cardiovasc J Afr
2013;
24
: 121–123
DOI: 10.5830/CVJA-2013-020
Cardiac surgery is one of the major fields necessitating blood
transfusion. Increasing numbers of cardiac surgery cases and
the requirement of large amounts of homologous blood and
blood products has long been a deterrent to this form of surgery.
This has forced surgeons to reduce their requirement for blood
and blood products for cardiopulmonary bypass procedures
and related surgical techniques.
1,2
Negative outcomes using
homologous blood transfusion, such as haemolytic, allergic and
febrile reactions, infections (hepatitis, cytomegalovirus, HIV),
renal problems, and transfusion-related acute lung injury have
cause severe morbidity and even mortality in some cases.
3,4
Several blood-conservation strategies have therefore evolved,
with major advances being achieved from pre-donation of
autologous blood, removal of autologous blood before bypass
and use of isovolumetric substitution, re-infusion of the volume
remaining in the extracorporal circuit, and autotransfusion
of the shed mediastinal drainage blood.
5
Other techniques,
using various devices for intra-operative haemofiltration and
haemoconcentration with cell separators, have been shown to
decrease homologous blood usage in cardiac surgery.
6
In this study we present our results on the use of homologous
blood with a simple blood-conservation protocol. This involved
removal of autologous blood before bypass and isovolumetric
substitution. The morbidity and mortality outcomes of this
protocol were compared in patients from two different surgical
eras.
Methods
Patients underwent isolated coronary artery bypass graft (CABG)
surgery at the Department of Cardiovascular Surgery, Gulhane
Military Academy of Medicine. Before 2008, CABG surgery
was performed using homologous blood; thereafter we began
using autologous blood.
According to the timeline, patients were retrospectively
divided into two groups. A total of 323 patients were included
in the study. The mean ages of the patients in groups 1 and 2
were 64.2
±
10.3 and 61.5
±
11.6 years, respectively. Thirty-
eight of the patients in group 1 and 30 in group 2 were female.
Mean NYHA class of the patients in both groups was II. The
autologous transfusion group (group 1) comprised 163 patients
and the homologous transfusion group (group 2) 160 patients.
Exclusion criteria were: patients with renal disease (creatinine
>
1.5 mg/dl), liver disease, coagulation disorders, anaemia
Department of Cardiovascular Surgery, Gulhane Military
Academy of Medicine, Ankara, Turkey
BILGEHAN SAVAS OZ, MD,
GOKHAN ARSLAN, MD
ERKAN KAYA, MD
CELALETTIN GUNAY, MD
FARUK CINGOZ, MD
MEHMET ARSLAN, MD
