Factors Influencing Blood Transfusion Requirements in Robotic Totally Endoscopic Coronary Artery Bypass Grafting on the Arrested Heart
1University of Maryland, Baltimore, MD, USA, 2Innsbruck Medical University, Innsbruck, Austria.
OBJECTIVE:
Robotic technology enables totally endoscopic coronary artery bypass grafting (TECAB) procedures. These operations can be performed both on the beating and on the arrested heart. One challenge of the latter version is a potentially increased need for blood transfusions. We investigated factors associated with transfusion requirements in TECAB on the arrested heart (AH-TECAB).
METHODS:
161 patients , 124 male, 37 female, age 59 (31-77) years, EuroSCORE 1 (0-7) underwent AH-TECAB using the daVinci telemanipulation system. The Heartport/CardiovationsTM or ESTECH-RAPTM systems were applied for remote access perfusion and aortic endoocclusion. The operations were carried out in moderate hypothermia and cold crystalloid cardioplegia mixed with blood was used in all cases.
RESULTS:
After 20 cases the blood transfusion rate dropped from 69% to 44%. The median overall number of transfusions was 1 (0-21). The following pre- and intraoperative factors showed a strong association with application of packed red blood cells (PRBC): preoperative hemoglobin level (p<0.001), female gender (p<0.001), shorter body height (p<0.001), lower body weight (p<0.001), long operative time (p<0.001) and long time on cardiopulmonary bypass (p=0.001), the occurrence of an intraoperative surgical problem (p<0.001), and conversion to a larger thoracic incision (p<0.001). Postoperatively patients with longer ventilation time (p<0.001), and those needing revision for bleeding (p<0.001) received significantly more PRBC.
CONCLUSIONS:
We conclude that multiple factors are associated with increased blood transfusion requirements in AH-TECAB. The transfusion rate is reduced with experience. Identification of these parameters may help in avoiding application of blood products in the next generation of AH-TECAB procedures.
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