Evaluation of CardioPAT R autotransfusion system in elective cardiac surgery.

1. Evaluation of CardioPATR autotransfusion system in elective cardiac surgery. De Decker K.1; Bogaert T2*; Gooris T2*; Stockman B2; 1: Dept of Anesthesiology and Intensive Care Medicine, 2: Department of cardiovascular surgery ( *Perfusionist) O.-L.-Vrouw Hospital Aalst, Belgium

2. Evaluation of CardioPATR autotransfusion system in elective cardiac surgery. • No conflict of interest

3. Evaluation of CardioPATR autotransfusion system in elective cardiac surgery. • RBC transfusion was an independent risk factor for clinical complications after cardiac surgery (1) • In order to reduce blood transfusion and consequently its immunological complications, several strategies have been investigated. • One of them is the use of cell saving devices and autologous transfusion. • With this intention the cardioPATR system (Haemonetics, Braintree, MA) was designed, which is • more flexible than classical cell saving devices • and thereby also very convenient for prolonged use in the postoperative period. 1. Transfusion requirements after cardiac surgery: The TRACS randomized controlled trial. JAMA 2010; 304(14): 1559-67.

4. Evaluation of CardioPATR autotransfusion system in elective cardiac surgery. Salvages red blood cells lost during and after cardiovascular surgery Concentrates and washes red cells to a hematocrit of 70% to 80% RBC recovery between 76% and 92% High quality RBC product Albumin removal : 97.1% - 99.9% Free hemoglobin removal 93.4% - 99.5% Heparin removal : 96.8% - 100% Small, portable and easy to use http://www.haemonetics.com/en/Products/Devices/Surgical%20-%20Diagnostic%20Devices/cardioPAT.aspx

5. Evaluation of CardioPATR autotransfusion system in elective cardiac surgery. • During the implementation phase of the device the following data were observed • perioperative blood loss • autologous transfusion rates • and especially the use of allogenic blood products • 523 cardiac surgery cases (M/F = 326/197 ; mean age 70 yr) • Used most frequently in CABG, mitral valve plasty and double (or triple) valve operations. • In 50 patients ( 9,5 %) a classical cell saver was used intraoperatively • In 18 patients cardioPAT was started postoperatively.

6. Evaluation of CardioPATR autotransfusion system in elective cardiac surgery.

7. Evaluation of CardioPATR autotransfusion system in elective cardiac surgery. • The transfusion trigger for was 9 g/dl of hemoglobin. • 79 patients received only 1 PC • Transfusion rates were higher (counting for nearly 29 % of all products) in • in redo cases (88 % of pats.; avg. 3, 7 U) • revised patients (100 % of pats; avg. 5 U)

8. Evaluation of CardioPATR autotransfusion system in elective cardiac surgery. • Postoperative period only : average of • 0, 61 PC/patient in 20 % (n = 102) of patients • 0,35 FFP • 0,14 pools of platelets • During the observation period a reduction of overall transfusion rates was seen • Packed cells : from 2.17 ( n = 100) to 1.63 PC/patient (n=523) • A similar decline was seen for FFP ( 0,36 -> 0,296 U )and platelets (0,96 to 0,71 U) • No device-related serious adverse events were noticed during the observation period.

9. Evaluation of CardioPATR autotransfusion system in elective cardiac surgery. • Around 30 well designed trials ( n = 2282) studied the use of cell saving and a meta-analysis showed that the exposure to any allogeneic blood product was decreased(2) • No difference in other outcome parameters • Almost all studies however deal with intraoperative use of cell saving, and in a majority of them only cardiotomy suction blood is retransfused • Only 1 RCT with CardioPATR in 512 patients (3) : • Comparing intra-operative classical cell saving with intra- and postoperative use of the cardioPAT system • Autologous transfusion : • 370 + 250 ml intraoperatively • 350 + 370 ml postoperatively • Reduction of allogeneic transfusion per patient • from 2,11 + 0,9 to 1.2 + 0,8 units • 37 % vs. 57,13 % of patients • Respectively 11,7 % and 18,8 % required 1 unit only 2. The efficacy of an intraoperative cell saver during cardiac surgery: a meta-analysis of randomized trials. Wang F, Bainbridge D, Martin J, Cheng D. Anesth Analg 2009;109:320-30. 3. Weltert L. et al. Reduction of allogeneic red blood cell usage during cardiac surgery by an integrated intra- and postoperative blood salvage strategy: results of a randomized comparison. Transfusion 2013; 53:790-7.

10. Evaluation of CardioPATR autotransfusion system in elective cardiac surgery. • Over 70 % patients received PC in historic control sample vs. 54,4 % in cardioPAT group • Excluding the patients receiving only 1 unit ( with trigger 9/dl) would further reduce the group of patients needing allogeneic PCs to 39 %. • The decrease in PC transfusion during the observation period was biased by a changing transfusion trigger . • Comparisons with literature data are difficult for several reasons (redo cases excluded , only postoperative used evaluated,..). • The average transfusion amount of 0,61 units of PC/patient however is comparable with literature data

11. Evaluation of CardioPATR autotransfusion system in elective cardiac surgery. • Autologous transfusion in elective cardiac surgery can be done safely with the CardioPATR auto transfusion device. • Due to the transfusion of autologous blood, allogeneic transfusion can be reduced especially in the postoperative period.

12. Acknowledgements Bogaert Thierry