Technique Article

Hematic Antegrade Repriming: A Reproducible Method to Decrease the Cardiopulmonary Bypass Insult

^* Cardiac Surgery Department (SCS), Virgen de la Arrixaca University Hospital, Murcia, Spain
^† SCS, University Hospital Agostino Gemelli, Rome, Italy
^‡ SCS Santiago de Compostela University Hospital, Santiago de Compostela, Spain
^§ Health Science Research Institute (IMIB), Murcia, Spain
^¶ Biostatistics Department, Medicine Faculty, University of Murcia, Murcia, Spain
^‖ Department of Bioengineering, Stanford University, Stanford, California

Address correspondence to: Juan Blanco-Morillo, MSc, Perfusionist, Cardiac Surgery Department (SCS), Virgen de la Arrixaca University Hospital, carretera Madrid-Cartagena s/n, Murcia 30120, Spain. E-mail: ikaroleon@gmail.com

Received: 10 August 2020
Accepted: 2 February 2021

Abstract

The current practice of cardiopulmonary bypass (CPB) requires a preoperative priming of the circuit that is frequently performed with crystalloid solutions. Crystalloid priming avoids massive embolism but is unable to eliminate all microbubbles contained in the circuit. In addition, it causes a sudden hemodilution which is correlated with transfusion requirements and an increased risk of cognitive impairment. Several repriming techniques using autologous blood, collectively termed retrograde autologous priming (RAP), have been demonstrated to reduce the hemodilutional impact of CPB. However, the current heterogeneity in the practice of RAP limits its evidence and benefits. Here, we describe hematic antegrade repriming as an easy and reliable method that could be applied with any circuit in the market to decrease transfusion requirements, emboli, and inflammatory responses, reducing costs and the impact of CPB on postoperative recovery.