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J Thorac Cardiovasc Surg 2005;130:20-28
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Safety, efficacy, and cost of intraoperative cell salvage and autotransfusion after off-pump coronary artery bypass surgery: A randomized trial

^a Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom.
^b Department of Clinical Perfusion, Bristol Royal Infirmary, Bristol, United Kingdom.
^c Department of Anaesthetics, Bristol Royal Infirmary, Bristol, United Kingdom

Received for publication September 30, 2004; revisions received November 17, 2004; accepted for publication December 7, 2004.

^_* Address for reprints: G. D. Angelini, MD, FRCS, Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom (Email: G.D.Angelini{at}bristol.ac.uk).

OBJECTIVE: We evaluated, in a randomized controlled trial, the safety and effectiveness of intraoperative cell salvage and autotransfusion of washed salvaged red blood cells after first-time coronary artery bypass grafting performed on the beating heart.

METHODS: Sixty-one patients undergoing off-pump coronary artery bypass grafting surgery were prospectively randomized to autotransfusion (n = 30; receiving autotransfused washed blood from intraoperative cell salvage) or control (n = 31; receiving homologous blood only as blood-replacement therapy). Homologous blood was given according to unit protocols.

RESULTS: The groups were well matched with respect to demographic and comorbid characteristics. Patients in the autotransfusion group had a significantly higher 24-hour postoperative hemoglobin concentration (11.9 g/dL; SD, 1.41 g/dL) than those in the control group (10.5 g/dL; SD, 1.37 g/dL) (mean difference, 1.02 g/dL; 95% confidence interval, 1.60-0.44 g/dL; P = .0007), as well as a 20% reduction in the frequency of homologous blood product use (11/31 vs 5/30; P = .095). Autotransfusion of washed red blood cells was not associated with any derangement of thromboelastograph values or laboratory measures of clotting pathway function (prothrombin time, activated partial thromboplastin time, and fibrinogen levels), increased postoperative bleeding, fluid requirements, or adverse clinical events. There was no statistical difference between groups in the total operation, hospitalization, and management costs per patient (median difference, $1015.90 [US dollars]; 95% confidence interval, –$2260 to $206; P = .11).

CONCLUSIONS: Intraoperative cell salvage and autotransfusion was associated with higher postoperative hemoglobin concentrations, a modest reduction in transfusion requirements, no adverse clinical or coagulopathic effects, and no significant increase in cost compared with controls. This study supports its routine use in off-pump coronary artery bypass grafting surgery.

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