Original Article

Haematic antegrade repriming to enhance recovery after cardiac surgery from the perfusionist side

¹ Cardiac Surgery Department, Virgen de la Arrixaca University Hospital, 30120 Murcia, Spain
² Department of Health and Social Sciences, Murcia University, 30120 Murcia, Spain
³ IMIB-Arrixaca, 30120 Murcia, Spain
⁴ CIBER Epidemiology and Public Health CIBERESP, 28029 Madrid, Spain
⁵ Cardiac Surgery Department, Agostino Gemelli University Policlinic, 00168 Rome, Italy
⁶ Department of Extra Corporeal Circulation, UZ Gasthuisberg, KU Leuven, 3000 Leuven, Belgium

^* Corresponding author: dsm@um.es

Received: 24 July 2022
Accepted: 11 January 2023

Abstract

Background: New era of cardiac surgery aims to provide an enhanced postoperative recovery through the implementation of every step of the process. Thus, perfusion strategy should adopt evidence-based measures to reduce the impact of cardiopulmonary bypass (CPB). Hematic Antegrade Repriming (HAR) provides a standardized procedure combining several measures to reduce haemodilutional priming to 300 mL. Once the safety of the procedure in terms of embolic release has been proven, the evaluation of its beneficial effects in terms of transfusion and ICU stay should be assessed to determine if could be considered for inclusion in Enhanced Recovery After Cardiac Surgery (ERACS) programs. Methods: Two retrospective and non-randomized cohorts of high-risk patients, with similar characteristics, were assessed with a propensity score matching model. The treatment group (HG) (n = 225) received the HAR. A historical cohort, exposed to conventional priming with 1350 mL of crystalloid confirmed the control group (CG) (n = 210). Results: Exposure to any transfusion was lower in treated (66.75% vs. 6.88%, p < 0.01). Prolonged mechanical ventilation (>10 h) (26.51% vs. 12.62%; p < 0.01) and extended ICU stay (>2 d) (47.47% vs. 31.19%; p < 0.01) were fewer for treated. HAR did not increase early morbidity and mortality. Related savings varied from 581 to 2741.94 $/patient, depending on if direct or global expenses were considered. Discussion: By reducing the gaseous and crystalloid emboli during CPB initiation, HAR seems to have a beneficial impact on recovery and reduces the overall transfusion until discharge, leading to significant cost savings per process. Due to the preliminary and retrospective nature of the research and its limitations, our findings should be validated by future prospective and randomized studies.