Inflammatory Response Due to Cell-Saver in Cardiac Surgery

Various technics have been proposed and evaluated clinically to avoid homologous blood transfusion in cardiac surgery. Transfusion of pre-deposited autologous blood appears quite unrealistic at a time when surgery is frequently performed as an urgent procedure. Reduction of blood loss, given by a precise surgical technique and pharmacological agents such as aprotinin, together with intra-operative autologous transfusion is a more practical approach. Previous reports by Royston [1] and our present prospective double-blind study on coronary patients clearly demonstrate that aprotinin is quite efficient in this attempt to minimize blood loss. Detailed analysis of blood loss during operations performed by different surgeons clearly shows the role of surgery itself. For obvious reasons, this observation is, nevertheless, not presented in the scientific literature. Finally, techniques of intra-operative autologous transfusion are now available. One of the most appealing is given by the red cell-saver (CS) which permits re-infusion of washed red cells, obtained from lost blood. The question of the increased blood trauma and whole-body inflammatory response due to this blood handling has not been addressed precisely. The purpose of the present paper is the study of the C3a generation, used as an index of the inflammatory response in cardiac surgery with red cell re-infusion obtained by a cell-saver.