Reinfusion of mediastinal blood in CABG patients: Impact on homologous transfusions and rate of re-exploration

Background: Reinfusion of mediastinal shed blood after cardiac surgery has been used in some centers to reduce exposure to homologous blood transfusions. The method has not been widely applied mostly because some studies have failed to demonstrate a significant benefit. Methods: A group of 675 consecutive patients undergoing first-time, isolated coronary artery bypass surgery (CABG) was studied. Prospective data was collected on the first 375 patients receiving autotransfusion (ATS) of mediastinal shed blood. The charts of 338 patients immediately preceding the institution of the ATS program at our Institution (NO ATS group) were retrospectively reviewed. Transfusion of homologous blood products and rate of re-exploration for bleeding were closely monitored. Results: The two groups were identical. The net blood loss was significantly less in the ATS group than in the NO ATS group (1013 ± 431 cc vs 1371 ± 631 cc, p < 0.0001). Rate of exploration for postoperative bleeding was 1.5% in the ATS group and 5.0% in the NO ATS group (p < 0.01). In the ATS group, 51.9% of patients were not exposed to any homologous blood product (vs 17.8% in the NO ATS group, p < 0.0001).The ATS patients received on the average 2.9 ± 7.2 units of blood products versus 6.4 ± 9.7 units in the NO ATS group (p < 0.0001). Conclusion: Reinfusion of mediastinal shed blood significantly reduces exposure to homologous blood transfusions and rate of re-exploration. The ATS system reduces the number of re-explorations for coagulopathy-related postoperative hemorrhage.