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Low-prime perfusion circuit and autologous priming in CABG surgery on a Jehova’s Witness: a case report

Department of Extracorporeal Circulation, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands, r.brestvankempen{at}planet.nl

J M Gasiorek

Department of Extracorporeal Circulation, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

K Bloemendaal

Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

R PH Storm van Leeuwen

Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

E R Bulder

Department of Anaesthesiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

Cardiac surgery on Jehovah’s Witnesses is a great challenge for the cardiothoracic surgery team and especially for the perfusionist. To reduce the risk of surgery in these patients, a very small extracorporeal circuit was designed to decrease the amount of priming volume and thereby the degree of hemodilution. A small bypass system was built, consisting of a 3/8-in. arterial line and a 3/8-in. venous line, a venous collapsible reservoir, a centrifugal pump, a hollow fiber oxygenator and a cell saver reservoir. The circuit priming volume was 650 ml. By using antegrade and retrograde autologous priming, the total amount of priming was reduced to ± 50 ml. Bypass time was 63 min with an average blood flow of 5300± 114 ml/min and postmembrane pressures of 180± 45 mmHg. Venous line pressure was monitored and kept between -8 and -20 mmHg with a mean arterial pressure (MAP) of 55± 12.3 mmHg. The hematocrit before extracorporeal circulation (ECC) was 36%, per-ECC 35% and post-ECC 35%. On the fifth postoperative day, the hematocrit was 40%. The patient was discharged 7 days after surgery. A low-prime circuit, in combination with autologous priming, seems to be safe and effective in avoiding the use of banked blood.

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