• J. Cardiothorac. Vasc. Anesth. · Aug 2022

    Observational Study

    Retrograde Autologous Priming for Minimally Invasive Mitral Valve Surgery.

    • Marco Moscarelli, Ignazio Condello, Anna Mancini, Valeria Rao, Flavio Fiore, Raffaele Bonifazi, Nicola Di Bari, Giuseppe Nasso, and Giuseppe Speziale.
    • Department of Cardiovascular Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy. Electronic address: m.moscarelli@imperial.ac.uk.
    • J. Cardiothorac. Vasc. Anesth. 2022 Aug 1; 36 (8 Pt B): 3028-3035.

    ObjectivesLittle is known about the safety and clinical utility of retrograde autologous priming (RAP) in patients undergoing minimally invasive mitral valve surgery. The study authors hypothesized that RAP would increase the oxygen delivery index (DO2i) while decreasing red blood cell transfusion requirements compared to valve surgery without RAP.DesignThe study was an observational analysis.SettingA single institutional study.ParticipantsThe authors analyzed data from 500 consecutive patients who underwent minimally invasive isolated mitral valve repair from December 31, 2012, to December 31, 2019.InterventionRAP was performed in 235 patients (47%) prior to the initiation of cardiopulmonary bypass (CPB).Measurement And Main ResultsA continuous monitoring system was used for DO2 management during CPB. The mean arterial pressure was maintained between 55 and 70 mmHg, and the cardiac index was set at 2.4 L/min/m2, with adjustments in accordance with DO2i. The trigger point for red cell blood transfusion during CPB was hemoglobin <7 g/dL. Baseline hematocrit was lower in the RAP group compared to the no-RAP group (33.4 ± 3.6 v 38.1 ± 4.9, respectively; p < 0.001). Both CPB and cross-clamp times were similar between groups. Hematocrit during CPB was significantly higher in the RAP group compared to the no-RAP group (27.6 ± 2.6 v 25.9 ± 5.1, respectively; p < 0.001). RAP was also associated with significantly higher mean DO2i (292 ± 19.5 v 282.9 ± 35.1 mL/min/m2, respectively; p < 0.001) and fewer red blood cells transfusions during the intraoperative and immediate postoperative periods (p < 0.001).ConclusionsIn a minimally invasive mitral valve context, RAP was safe and associated with better DO2i, higher hematocrit, and fewer intraoperative and postoperative red blood cell transfusions.Copyright © 2022 Elsevier Inc. All rights reserved.

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