Haematic Antegrade Repriming: a method for a safer cardiopulmonary bypass initiation.

Abstract

Introduction: Cardiopulmonary bypass is a safe technique frequently required in cardiac surgery. Despite that, it carries several undesired effects related to haemodilution, emboli and alterations on the coagulation and microcirculation. Different strategies like the minimized circuits (MiECC) or the retrograde autologous priming have attemped to reduce its impact, but finally lead to inconsistent results as independent measures due to the heterogeneity on its practice. The haematic antegrade repriming detailes a standardized materials and methodology that could offer a reproducible method inspired in evidence-based recommendations.
Description of the technique: The haematic antegrade repriming is performed in a standardized Class IV minimized circuit that is reprimed antegradely with autologous blood obtained from the aorta of the patient, before the cardiopulmonary bypass initiation. Then, cardiopulmonary bypass is started with the support of vacuum assisted venous drainage.
Discussion: The strict application of haematic antegrade repriming results in a fix haemodilution of 300 ml of crystalloid priming, avoiding the sudden haemodilution and the crystalloid embolism at cardiopulmonary bypass initiation. The synergic effect that converges in haematic antegrade repriming could exceed the evidence-based benefits of retrograde autologous priming, minimized circuit and vacuum assisted venous drainage promising to improve the outcomes in terms of transfusion, complications, stay and survival.
Conclusions: Haematic antegrade repriming is proposed as a new approach to increase the safety of the cardiopulmonary bypass. Its overall benefits should be properly assessed and validated by current and further studies.