Combination autotransfusion in heart surgery. Use of acute normovolemic hemodilution in coronary heart disease

: Normovolemic hemodilution (15 mg/kg body-weight: group I) was undertaken in 100 patients immediately before the start of coronary-artery surgery. In addition, a Cell-Saver (Haemonetics, Munich) was used for intra-operative autotransfusion. Another group of 100 patients (group II) was similarly operated on without autotransfusion (the study was conducted on 200 consecutive patients undergoing aorto-coronary bypass). Before blood (autologous or homologous) was administered a reduction of hemoglobin to 9 g/100 ml and hematocrit to 0.28 was well tolerated (during extracorporeal circulation: 6.5 g/100 ml and 0.16, respectively). Due to intra- and postoperative complications, such as infarct bleeding (including reoperation) or septicemia, the number of patients placed in group I fell to 94, that in group II to 90. Acute normovolemic hemodilution increased cardiac output and oxygen transport capacity, while other hemodynamic parameters remained unchanged, and there was no effect on extravascular lung water. Autotransfusion reduced the need for homologous blood derivatives by 71% (fresh blood, fresh plasma, RBC concentrates). No clinically significant disadvantages occurred.