Gabrielle Li BA , Alex M. Wisniewski MD , Raymond J. Strobel MD, MSc , Evelynn Dallas CCP , Kenan Yount MD, MBA , Leora Yarboro MD , Karen Singh MD , John Kern MD , Nicholas R. Teman MD , Jared P. Beller MD
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引用次数: 0
Abstract
Objective
Coronary artery bypass grafting is associated with a significant risk of blood transfusion. The clinical efficacy of retrograde autologous priming, a potential blood conservation strategy, lacks consensus. We aim to evaluate the effect of retrograde autologous priming on transfusion requirements and clinical outcomes in patients undergoing coronary artery bypass grafting.
Methods
A retrospective review was conducted on all patients undergoing on-pump, isolated coronary artery bypass grafting between October 2018 and March 2023 at a single institution. Those undergoing retrograde autologous priming were identified and compared with non–retrograde autologous priming cases. Wilcoxon rank-sum and chi-square analyses were used to analyze continuous and categorical outcomes, respectively. Risk-adjusted multivariable logistic regression was performed.
Results
A total of 1109 patients met inclusion criteria, with 332 (29.9%) receiving retrograde autologous priming. At baseline, patients in the retrograde autologous priming group had higher preoperative hemoglobin (14.0 g/dL vs 13.7 g/dL, P = .03), higher nadir intraoperative hemoglobin (10.2 g/dL vs 9.7 g/dL, P < .0), and less total crystalloid use (900 mL vs 110 0 mL, P < .01) in the operating room. On risk-adjusted analysis, including adjustment for preoperative hemoglobin levels, retrograde autologous priming was found to significantly reduce the risk of postoperative blood transfusion (odds ratio, 0.54, P < .01) and postoperative prolonged ventilation (odds ratio, 0.47, P = .02).
Conclusions
Use of retrograde autologous priming may result in fewer transfusions and thus potentially prevent transfusion-associated risks such as prolonged ventilation. Potential mechanisms include avoidance of volume overload and transfusion-related acute lung injury. Retrograde autologous priming should be considered in appropriately selected patients undergoing cardiac surgery.
目的冠状动脉旁路移植术存在较大的输血风险。逆行自体启动作为一种潜在的血液保护策略，其临床疗效缺乏共识。我们的目的是评估逆行自体启动对冠状动脉旁路移植术患者输血需求和临床结果的影响。方法回顾性分析2018年10月至2023年3月在同一医院接受无泵离体冠状动脉旁路移植术的所有患者。进行逆行自体启动的患者被鉴定并与非逆行自体启动病例进行比较。使用Wilcoxon秩和和卡方分析分别分析连续和分类结果。进行风险调整多变量logistic回归。结果1109例患者符合纳入标准，其中332例（29.9%）接受逆行自体启动。在基线时，逆行自体启动组患者术前血红蛋白较高（14.0 g/dL vs 13.7 g/dL, P = 0.03），术中最低血红蛋白较高(10.2 g/dL vs 9.7 g/dL, P <；.0)，总晶体用量更少(900 mL vs 110 mL, P <；.01)在手术室。在风险调整分析中，包括术前血红蛋白水平的调整，逆行自体启动可显著降低术后输血风险(优势比，0.54,P <；.01)和术后延长通气（优势比0.47,P = .02）。结论逆行自体启动可减少输血量，从而有可能预防输血相关风险，如延长通气时间。潜在的机制包括避免容量过载和输血相关的急性肺损伤。在接受心脏手术的患者中，应考虑逆行自体启动。
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