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HAR, the 6 steps procedure. Step 1: The circuit is primed with 1000 mL of a balanced crystalloid solution. Then, venous and arterial lines are clamped. Step 2: Venous line content is drained to the reservoir by activating vacuum-assisted venous drainage (VAVD) and removing the venous clamp. Step 3: removing the arterial line clamp that is proximal to the patient and opening the arterial line recirculation, autologous blood discurs retrogradely pushing the crystalloid priming to the reservoir. Then, the arterial recirculation line clamp is closed to avoid blood mixing in the reservoir. Step 4: By opening the recirculation line of the oxygenator and setting the centrifugal pump (CP) to 2000 rpm, crystalloid priming is discarded into the collector bag until zero level in the reservoir is reached. Step 5: A clamp is placed after the reservoir and arterial line recirculation is opened again. Thus, retrogradely, 300 mL of arterial blood is sequestered in the reservoir (100–200 mL/min). Step 6: Setting CP to 2000 rpm and opening the recirculation line of the oxygenator and removing the clamp after the reservoir, CP and oxygenator are reprimed with autologous blood, displacing the priming and GME to the collector bag reducing haemodilution to only 300 mL. *CPB is initiated with VAVD activation once the venous return is obtained. Adapted from: [17].

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