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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 307-314, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RG Johnson, RL Thurer, MS Kruskall, C Sirois, EV Gervino, J Critchlow and RM Weintraub
We performed a prospective, randomized trial of two different strategies
for postoperative packed red blood cell replacement in 39 autologous blood
donors undergoing elective myocardial revascularization. The "liberal"
group received blood to achieve a hematocrit value of 32%, and the
"conservative" group received transfusions for a hematocrit value less than
25%. Although the groups had significantly different mean hematocrit values
from the fourth postoperative hour (28.7% versus 31.2%) through the fifth
postoperative day (28.4% versus 31.3%), there were no significant
differences in fluid requirement, hemodynamic parameters, or hospital
complications. Significantly fewer units of packed cells were required in
the conservatively transfused group (20 units/20 patients) compared with
the liberally transfused group (37 units/18 patients) (p = 0.012). Exercise
tests were performed on the fifth and sixth postoperative days, with a
transfusion being given to the conservative group between tests. Although a
significant improvement in exercise endurance occurred in the conservative
group receiving a transfusion (p = 0.008), no significant difference in
duration or degree of exercise was demonstrated between the two groups on
either day. In comparing these two groups of profoundly anemic patients, we
identified no adverse consequence associated with the greater degree of
hemodilution and could identify no correlation between hematocrit value and
exercise capacity. We conclude that although the limits of hemodilution are
still poorly defined, postoperative blood transfusion in revascularized
patients should be guided by clinical indications and not by specific
hematocrit values.
ARTICLES
Comparison of two transfusion strategies after elective operations for myocardial revascularization
Division of Cardiothoracic Surgery, Beth Israel Hospital, Boston, Mass. 02215.
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