[Cell saver devices in coronary revascularization surgery without extracorporeal circulation reduce transfusion requirements]. / El Recuperador Celular (Cell Saver) en cirugía de revascularización coronaria sin circulación extracorpóea reduce necesidades transfusionales.

OBJECTIVES: To analyze the effectiveness of a cell saver device in reducing transfusion requirements in patients undergoing off-pump coronary artery bypass surgery. PATIENTS AND METHODS: Fifty-six consecutive ASA class 4-5 patients who underwent coronary surgery without extracorporeal circulation in our cardiac surgery department between June 2004 and January 2005 were included in this retrospective study; the series comprised 28 patients who received conventional management (control group) without use of the cell saver device and 28 who received cell saver treatment. Variables analyzed were preoperative and discharge hemoglobin levels and hematocrit values, age, weight, height, ejection fraction, packed red blood cells transfused, exitus, and adverse events. RESULTS: The groups were similar with respect to preoperative characteristics. Fewer patients in the cell saver group required transfusions (6 vs 18 in the control group; relative risk 0.33, 95% confidence interval, 0.16-0.71). The mean amount of packed red cells transfused was greater in the control group than in the cell saver group (2.5 L vs 1.2 L, P = 0.03). No deaths or adverse events occurred in either group. CONCLUSIONS: The routine use of a cell saver device during off-pump coronary artery bypass surgery reduces the need for postoperative transfusions and is not associated with adverse events. Cell saver devices should be used routinely, especially in situations where the ability to provide blood transfusions may be compromised.

El Recuperador Celular (Cell Saver) en cirugía de revascularización coronaria sin circulación extracorpórea reduce necesidades transfusionales / Cell saver devices in coronary revascularization surgery without extracorporeal circulation reduce transfusión requirements

OBJETIVOS: Comprobar la eficacia en la reducción detransfusiones del recuperador celular en cirugía coronariaen pacientes que no se someten a circulación extracorpórea.PACIENTES Y MÉTODOS: 56 pacientes consecutivos conriesgo ASA III-IV operados desde junio de 2004 hastaenero de 2005 de cirugía coronaria sin circulación extracorpóreaen un Servicio de Cirugía Cardiaca. Estudioobservacional de cohortes retrospectivo. 28 pacientes(Grupo Control) fueron intervenidos de forma convencionalsin recuperador celular, y en 28 pacientes (GrupoEstudio) se empleó el recuperador celular (Cell Saver).Se determinó: Hemoglobina y Hematocrito preoperatoriosy al alta, edad, peso, talla, fracción de eyección, concentradosde hematíes trasfundidos, exitus y resultadosadversos.RESULTADOS: Las dos poblaciones han resultadohomogéneas en cuanto a criterios demográficos preoperatorios.En el grupo II (con recuperador) precisarontransfusiones menos pacientes (6 vs. 18, RR 0,33 IC 95%0,16-0,71). Se transfundieron más concentrados dehematíes de media en el grupo sin recuperador (2,5 vs1,2, p=0,03). No hubo exitus ni resultados adversos enninguno de los dos grupos.CONCLUSIONES: El uso rutinario de recuperador celularen cirugía coronaria sin bomba reduce las necesidadestransfusionales postoperatorias y no está asociadocon efectos adversos. Su empleo debe considerarse comoprocedimiento habitual de actuación, especialmente enmedios o situaciones en los que la disponibilidad de sangrepuede estar comprometida

OBJECTIVES: To analyze the effectiveness of a cellsaver device in reducing transfusion requirements inpatients undergoing off-pump coronary artery bypasssurgery.PATIENTS AND METHODS: Fifty-six consecutive ASAclass 4-5 patients who underwent coronary surgery withoutextracorporeal circulation in our cardiac surgerydepartment between June 2004 and January 2005 wereincluded in this retrospective study; the series comprised28 patients who received conventional management(control group) without use of the cell saver deviceand 28 who received cell saver treatment. Variablesanalyzed were preoperative and discharge hemoglobinlevels and hematocrit values, age, weight, height, ejectionfraction, packed red blood cells transfused, exitus,and adverse events.RESULTS: The groups were similar with respect topreoperative characteristics. Fewer patients in the cellsaver group required transfusions (6 vs 18 in the controlgroup; relative risk 0.33, 95% confidence interval,0.16-0.71). The mean amount of packed red cells transfusedwas greater in the control group than in the cellsaver group (2.5 L vs 1.2 L, P=0.03). No deaths oradverse events occurred in either group.CONCLUSIONS: The routine use of a cell saver deviceduring off-pump coronary artery bypass surgery reducesthe need for postoperative transfusions and is notassociated with adverse events. Cell saver devicesshould be used routinely, especially in situations wherethe ability to provide blood transfusions may be compromised

Mortality prediction in cardiac surgery patients: comparative performance of Parsonnet and general severity systems.

BACKGROUND: Our purpose was to assess the performance of general severity systems (Acute Physiology and Chronic Health Evaluation [APACHE], Simplified Acute Physiology Score [SAPS], and Mortality Probability Models [MPM]) and to compare them with the Parsonnet score to predict mortality after cardiac surgery. METHODS AND RESULTS: This was a prospective observational study of 465 cardiac surgery patients in a tertiary referral center. Probabilities of hospital death for patients were estimated by applying the 4 models and were compared with actual mortality rates. Performance of the 4 systems was assessed by evaluating calibration with the Hosmer-Lemeshow goodness-of-fit test and discrimination with receiver operating characteristic (ROC) curves. chi2 values were 3. 71 for Parsonnet, 4.52 for MPM II0, 4.30 for MPM II24, 5.16 for SAPS II, and 10.57 for APACHE II. The area under the ROC curve was 0.857 for Parsonnet, 0.783 for MPM II0, 0.796 for MPM II24, 0.771 for SAPS II, and 0.803 for APACHE II. CONCLUSIONS: In our experience, the Parsonnet score performs very well, with calibration and discrimination very high, better than general severity systems, and it is an appropriate tool to assess mortality in cardiac surgery patients. In our experience, the general severity systems perform well to predict mortality after cardiac surgery, with high calibration of MPM II24, MPM II0, and SAPS II; minor calibration for APACHE II; and high discrimination for 3 general systems, but not as well as the Parsonnet score.