Cell saving systems do not reduce the need of transfusion in low-risk patients undergoing cardiac surgery

Objective: Cell saving systems have been widely used to reduce blood loss and need of transfusions. These device are mainly indicated in complex cardiac surgery procedures and in those patients with a high risk of bleeding. However, it is not clear if there is a benefit of a cell saver (CS) system in low-risk patients undergoing cardiac surgery. Our aim was to analyze if the use of CS systems reduce the need of blood products in low-risk patients undergoing cardiac surgery. Methods: Between February and June 2009 all low-risk patients (EuroSCORE < 10%) undergoing coronary or valve procedure were selected (n = 63). Exclusion criteria were: combined procedure, aorta procedure, redo surgery, emergency procedures, creatinine levels > 2 mg/ml, anemic patients and patients with a body surface area (BSA) < 1.6 m(2). Patients were randomized to undergo cardiac surgery with a cell saving system (group CS) (n = 34) or without (control group, CO) (n = 29). All patients received tranexamic acid during the procedure. Need of blood products and clinical outcomes were analyzed in both groups. Results: Mean age was 64.7 +/- 12.3 years old with 33% of female patients. Baseline clinical characteristics and preoperative blood count cell were similar in both groups. Mean CS blood reinfused was 461 +/- 174 ml (maximum: 985 minimum: 259). A total of 59 red blood packages were transfused in 25 patients (mean 1.02 +/- 1.3; range: 0-5). The proportion of patients being transfused was similar in both groups (CS: 40% vs. CO: 46.4%; P = 0.79). Eleven plasma packages were transfused (CS: 8 vs. CO: 3; P = 0.77) and three platelet pools were used in group CS and none in group CO (P = 0.08). Multivariate analysis showed that preoperative hemoglobin levels > 13.3 g/dl [relative risk (RR): 0.29; confidence interval (CI): 0.09-0.99]and BSA > 1.74 (RR: 0.19; CI: 0.54-0.68) were protective against blood transfusion. Conclusions: In low-risk patients CS system did not reduce the need of blood transfusion. Clinical outcomes were similar regardless of the use of a cell saver system. A low preoperative hemoglobin level and a low BSA were related with the use of blood products. (c) 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.