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J Thorac Cardiovasc Surg 2000;120:499-504
© 2000 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Reinfusion of mediastinal blood after heart surgery

From the Departments of Surgery^a and Anesthesia^b and the Laboratory of Hematology,^c Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada; and Biostatistics Consulting Service,^d Memorial Sloan-Kettering Cancer Center, New York, NY.

Address for reprints: Michel Carrier, MD, Department of Surgery, Montreal Heart Institute, 500 Belanger St E, Montreal, QC H1T 1C8, Canada (E-mail: carrier{at}icm.umontreal.ca ).

Background: Several authors studying autotransfusion of shed mediastinal blood in patients undergoing heart operations have published conflicting results regarding reduction of the need for homologous blood transfusion. The effect on coagulation parameters is also unclear.
Methods: In a prospective randomized study, 198 patients who underwent coronary artery bypass grafting or a valvular operation were divided into 2 groups: a group with autotransfusion of shed mediastinal blood after an operation and a control group. Continuous reinfusion of mediastinal blood was done until no drainage was present or for a period of 12 hours after the operation. The amount of blood lost and autotransfused, the number of homologous blood products transfused, and the coagulation parameters were monitored.
Results: The number of patients requiring homologous blood transfusion was significantly different between the 2 groups (54/98 [55%] in autotransfused patients vs 73/100 [73%] in the control group, P = .01). The number of re-explorations for excessive bleeding was similar in the 2 groups (7/98 [7.1%] vs 8/100 [8%]), but the amount of blood collected postoperatively was higher in the autotransfused patients compared with control patients (1200 ± 201 mL vs 758 ± 152 mL, P = .0007). Coagulation parameters analyzed and complication rates were similar in the 2 groups after the operations.
Conclusion: Autotransfusion of shed mediastinal blood reduces the need for homologous blood transfusion in patients undergoing various cardiac operations. The cause of increased shed blood in patients undergoing autotransfusion remains unclear.

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