Retrograde autologous priming: is it useful in elective on-pump coronary artery bypass surgery? Gregory P Eising, MD, Martin Pfauder, Markus Niemeyer,

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Fig. 4 The blood path conversion to VAD by relocating the tubing clamps. Stasis in the oxygenator is avoided by recirculating its volume, thus allowing.

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Presentation transcript:

Retrograde autologous priming: is it useful in elective on-pump coronary artery bypass surgery? Gregory P Eising, MD, Martin Pfauder, Markus Niemeyer, Peter Tassani, MD, Hubert Schad, MD, Robert Bauernschmitt, MD, Rüdiger Lange, MD The Annals of Thoracic Surgery Volume 75, Issue 1, Pages 23-27 (January 2003) DOI: 10.1016/S0003-4975(02)04099-7

Fig 1 Scheme of the modified retrograde autologous priming (RAP) technique. Before RAP is started, mean arterial pressure is elevated to approximately 100 mm Hg using small doses of intravenously administered phenylephrine. (1) A recirculation bag is connected to the venous line and the crystalloid priming fluid of the venous reservoir is drained to a minimal level. The venous line is then drained, slowly replacing the crystalloid priming volume by filling the circuit with the patient’s blood. (2) The recirculation bag is disconnected from the venous line and connected with the purge line of the arterial filter. The draining of the venous line is then continued until the blood volume in the reservoir reaches approximately 200 mL. This fluid mixture of the reservoir is slowly pumped through the membrane oxygenator and the arterial filter, displacing the priming fluid of the tubing, the oxygenator, and the arterial filter into the recirculation bag. The arterial line connecting the patient with the arterial filter is clamped at that time. (3) The arterial line is drained into the recirculation bag by replacing the crystalloid fluid with the patient’s blood. (4) The recirculation bag is then reconnected with the venous reservoir for subsequent fluid replacement. The Annals of Thoracic Surgery 2003 75, 23-27DOI: (10.1016/S0003-4975(02)04099-7)

Fig 2 Change of plasma colloid osmotic pressure (COP) as percent of the preoperative level (pre–cardiopulmonary bypass [CPB] = 100%), during CPB, and in the intensive care unit in patients treated with retrograde autologous priming (closed circles) or with standard prime (control, open circles). Included are the exact percent values. *p= between the two groups. The Annals of Thoracic Surgery 2003 75, 23-27DOI: (10.1016/S0003-4975(02)04099-7)

Fig 3 Change of extravascular lung water (EVLW) as percent of the preoperative level (pre–cardiopulmonary bypass [CPB] = 100%) at 2, 4, and 18 hours after CPB in patients treated with retrograde autologous priming (closed circles) or with standard prime (control, open circles). Included are the exact percent values. *p= between the two groups; #p= postoperative versus preoperative. The Annals of Thoracic Surgery 2003 75, 23-27DOI: (10.1016/S0003-4975(02)04099-7)