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

2. Evaluation of CardioPAT R autotransfusion system in elective cardiac surgery. No conflict of interest

3. Evaluation of CardioPAT R 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 cardioPAT R 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 CardioPAT R 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 CardioPAT R 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 CardioPAT R autotransfusion system in elective cardiac surgery.

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

12. Acknowledgements Bogaert Thierry