Key result
Retrograde autologous priming during CABG was associated with lower blood transfusion and drainage requirements (P=0.001), with hemodynamic instability risk minimized at BSA >1.73 and CVP >4.5.
Why the study?
During retrograde autologous priming (RAP), some patients develop hypotension and hemodynamic instability that impedes the procedure, warranting evaluation of its effects on transfusion requirements and hemodynamic instability.
Does retrograde autologous priming reduce transfusion requirements and impact hemodynamic instability in patients undergoing isolated coronary artery bypass surgery?
Cohort (n=443)
Does retrograde autologous priming reduce transfusion requirements and impact hemodynamic instability in patients undergoing isolated coronary artery bypass surgery?
p-value: p=0.001
Retrograde autologous priming during CABG reduces blood transfusion requirements and postoperative drainage, with minimal risk of hemodynamic instability in patients with BSA >1.73 and baseline CVP >4.5.
During retrograde autologous priming (RAP), some patients develop hypotension and hemodynamic instability, which impedes the procedure. This study aimed to demonstrate the effects of RAP on transfusion requirements and the development of hemodynamic instability. Overall, 443 patients who were operated upon for coronary artery bypass surgery (CABG) between January 2017 and December 2022 were enrolled and examined, including 162 who underwent RAP (RAP group) and 281 who did not (non-RAP group). Further, data regarding demographic characteristics, preoperative and intraoperative characteristics, and postoperative outcomes of both groups were analyzed. The demographic characteristics and intraoperative data were similar between both groups. Meanwhile, the amount of intraoperative and postoperative blood transfusion and postoperative drainage was lower in the RAP group than in the non-RAP group (P = .001 and .001, respectively). The length of intensive care unit (ICU) stay was shorter in the RAP group, whereas the length of overall hospital stay was the same in both groups. In 17% of the RAP patients, the procedure was terminated following hemodynamic instability. Further, regression analysis revealed body surface area (BSA) and baseline central venous pressure (CVP) as risk factors for the development of hemodynamic instability. In the receiver operating characteristic (ROC) curve analysis, the cutoff values for BSA and CVP were found to be 1.73 (sensitivity = 84.2%, specificity = 80.3%, the area under the ROC curve [AUC] = 0.905) and 4.5 (sensitivity = 97.7%, specificity = 99.7%, AUC = 0.994), respectively. Our finding suggest that RAP is associated with a reduction in the requirement in blood transfusion during both intra-and postoperative periods, as well as a decrease in postoperative drainage. Additionally, the risk of hemodynamic instability during RAP appears to be minimal in patients with a body surface area (BSA) >1.73 and a baseline CVP exceeding 4.5.
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Erol et al. (2024) conducted a cohort in Coronary artery bypass surgery (CABG) (n=443). Retrograde autologous priming (RAP) vs. No RAP was evaluated on Intraoperative and postoperative blood transfusion and postoperative drainage (p=0.001). Retrograde autologous priming during CABG was associated with lower blood transfusion and drainage requirements (P=0.001), with hemodynamic instability risk minimized at BSA >1.73 and CVP >4.5.
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