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Coronary artery bypass grafting surgery without the routine application of blood products: is it feasible?

Coronary artery bypass grafting surgery without the routine application of blood products: is it... Downloaded from https://academic.oup.com/ejcts/article-abstract/20/5/1078/386808 by DeepDyve user on 04 July 2020 European Journal of Cardio-thoracic Surgery 20 (2001) 1078 www.elsevier.com/locate/ejcts Letter to the Editor Coronary artery bypass grafting surgery without the routine application of blood products: is it feasible? P.R. Belcher , E.W. Muriithi University Department of Cardiac Surgery, The Royal Infirmary, 10 Alexandra Parade, Glasgow, Scotland, G31 2ER, UK Received 3 July 2001; accepted 20 July 2001 This study [1] revisits old territory. Operations upon References Jehovah’s witnesses until recently had to be performed [1] Wilhelmi M, Franke U, Cohnert T, Weber P, Kaukemu ¨ ller J, Fischer without the use of blood products and there is an extensive S, Wahlers T, Haverich A. Coronary artery bypass grafting surgery literature relating to this particular problem [2], and blood without the routine application of blood products: is it feasible? Eur J saving manoeuvres in general [3,4]. It is hard to understand Cardio-thorac Surg 2001(19):657–661. how the authors can state that ‘Fresh frozen plasma (FFP) [2] Sandiford FM, Chiariello L, Hallman GL, Cooley DA. Aorto–coron- ary bypass in Jehovah’s witnesses. J Thorac Cardiovasc Surg substitution is currently standard practice in cardiac 1974;68:1–7. surgery’. Don’t they just mean their own unit? Because it [3] Cooley DA, Bloodwell RD, Beall AC, Hallman GL. Cardiac valve is certainly not standard in the UK or USA. replacement without blood transfusion. Am J Surg 1966;112:743– It was interesting that they used hydroxyethyl starch as their control volume expander. I [5], among others [6,7], [4] Zubiate P, Kay JH, Mendez AM, Krohn BG, Hochman R, Dunne EF. Coronary artery surgery — a new technique with use of little blood if was able to show that hetastarch-treated patients had the any. J Thorac Cardiovasc Surg 1974;68:263–267. same mediastinal blood loss as albumin-treated patients. [5] Belcher P, Lennox SC. Avoidance of blood transfusion in coronary Therefore it is hard to follow why Wilhelmi et al. carried artery surgery: a trial of hydroxyethyl starch. Ann Thorac Surg out a trial of a treatment already demonstrated to be ineffec- 1984;37:365–370. tive in two studies cited by the authors. Be ´lisle and Hardy, in [6] Diehl JT, Lester JL, Cosgrove DM. Clinical comparison of hetastarch and albumin in postoperative cardiac patients. Ann Thorac Surg their careful review of the literature until 1996 concluded 1982;34:674. that transfusion practice remained institution-dependent [7] Kirklin JK, Lell WA, Kouchoukos NT. Hydroxyethyl starch versus rather than guided by an appreciation of the literature [8]. albumin for colloid infusion following cardiopulmonary bypass in As the authors earliest cited article was from 1985 we patients undergoing myocardial revascularization. Ann Thorac Surg consider that their study was incompletely researched. 1984;37:40. [8] Be ´lisle S, Hardy JF. Hemorrhage and the use of blood products after Another point of issue is the uncritical statement that FFP adult cardiac operations: myths and realities. Ann Thorac Surg has been used routinely to counteract platelet dysfunction. 1996;62:1908–1917. In the articles cited there is no evidence for this assertion [9] Menys VC, Belcher PR, Noble MIM, Evans RD, Drossos GE, Pillai and on pathophysiological grounds there is no basis for R, Westaby S. macroaggregation of platelets in plasma, as distinct connecting FFP with the platelet defect associated with from microaggregation in whole blood (and plasma), as determined using optical aggregometry and platelet counting respectively, is cardiopulmonary bypass. This we, among others, have specifically impaired following cardiopulmonary bypass in man. defined as the failure to form large stable aggregates Thromb Haemost 1994;72:511–518. (macroaggregation) while the formation of small aggregates [10] Belcher PR, Muriithi EW, Milne EM, Wanikiat P, Wheatley DJ, (microaggregation) is unaffected [9–11]. We have also Armstrong RA. Heparin, platelet aggregation, neutrophils and cardi- shown that this is a consequence of heparinisation and opulmonary bypass. Thromb Res 2000;98:249–256. [11] Kawahito K, Kobayashi E, Iwasa H, Misawa Y, Fuse K. Platelet that the influence of extracorporeal circulation is limited aggregation during cardiopulmonary bypass evaluated by a laser [12]. light-scattering method. Ann Thorac Surg 1999:79–84. Is it feasible? It certainly is and has been so for 35 years. [12] Muriithi EW, Belcher PR, Rao JN, Chaudhry MA, Nicol D, Wheatley DJ. The effect of heparin and extracorporeal circulation on platelet counts and platelet microaggregation during cardiopulmonary bypass. J Thorac Cardiovasc Surg 2000;120:538–543. * Corresponding author. E-mail address: pbelcher@clinmed.gla.ac.uk (P.R. Belcher). 1010-7940/01/$ - see front matter q 2001 Elsevier Science B.V. All rights reserved. PII: S 1 0 1 0 - 7940(01)0093 5-6 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Coronary artery bypass grafting surgery without the routine application of blood products: is it feasible?

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References (14)

Publisher
Oxford University Press
Copyright
© 2001 Elsevier Science B.V. All rights reserved.
Subject
Letter to the Editor
ISSN
1010-7940
eISSN
1873-734X
DOI
10.1016/S1010-7940(01)00935-6
Publisher site
See Article on Publisher Site

Abstract

Downloaded from https://academic.oup.com/ejcts/article-abstract/20/5/1078/386808 by DeepDyve user on 04 July 2020 European Journal of Cardio-thoracic Surgery 20 (2001) 1078 www.elsevier.com/locate/ejcts Letter to the Editor Coronary artery bypass grafting surgery without the routine application of blood products: is it feasible? P.R. Belcher , E.W. Muriithi University Department of Cardiac Surgery, The Royal Infirmary, 10 Alexandra Parade, Glasgow, Scotland, G31 2ER, UK Received 3 July 2001; accepted 20 July 2001 This study [1] revisits old territory. Operations upon References Jehovah’s witnesses until recently had to be performed [1] Wilhelmi M, Franke U, Cohnert T, Weber P, Kaukemu ¨ ller J, Fischer without the use of blood products and there is an extensive S, Wahlers T, Haverich A. Coronary artery bypass grafting surgery literature relating to this particular problem [2], and blood without the routine application of blood products: is it feasible? Eur J saving manoeuvres in general [3,4]. It is hard to understand Cardio-thorac Surg 2001(19):657–661. how the authors can state that ‘Fresh frozen plasma (FFP) [2] Sandiford FM, Chiariello L, Hallman GL, Cooley DA. Aorto–coron- ary bypass in Jehovah’s witnesses. J Thorac Cardiovasc Surg substitution is currently standard practice in cardiac 1974;68:1–7. surgery’. Don’t they just mean their own unit? Because it [3] Cooley DA, Bloodwell RD, Beall AC, Hallman GL. Cardiac valve is certainly not standard in the UK or USA. replacement without blood transfusion. Am J Surg 1966;112:743– It was interesting that they used hydroxyethyl starch as their control volume expander. I [5], among others [6,7], [4] Zubiate P, Kay JH, Mendez AM, Krohn BG, Hochman R, Dunne EF. Coronary artery surgery — a new technique with use of little blood if was able to show that hetastarch-treated patients had the any. J Thorac Cardiovasc Surg 1974;68:263–267. same mediastinal blood loss as albumin-treated patients. [5] Belcher P, Lennox SC. Avoidance of blood transfusion in coronary Therefore it is hard to follow why Wilhelmi et al. carried artery surgery: a trial of hydroxyethyl starch. Ann Thorac Surg out a trial of a treatment already demonstrated to be ineffec- 1984;37:365–370. tive in two studies cited by the authors. Be ´lisle and Hardy, in [6] Diehl JT, Lester JL, Cosgrove DM. Clinical comparison of hetastarch and albumin in postoperative cardiac patients. Ann Thorac Surg their careful review of the literature until 1996 concluded 1982;34:674. that transfusion practice remained institution-dependent [7] Kirklin JK, Lell WA, Kouchoukos NT. Hydroxyethyl starch versus rather than guided by an appreciation of the literature [8]. albumin for colloid infusion following cardiopulmonary bypass in As the authors earliest cited article was from 1985 we patients undergoing myocardial revascularization. Ann Thorac Surg consider that their study was incompletely researched. 1984;37:40. [8] Be ´lisle S, Hardy JF. Hemorrhage and the use of blood products after Another point of issue is the uncritical statement that FFP adult cardiac operations: myths and realities. Ann Thorac Surg has been used routinely to counteract platelet dysfunction. 1996;62:1908–1917. In the articles cited there is no evidence for this assertion [9] Menys VC, Belcher PR, Noble MIM, Evans RD, Drossos GE, Pillai and on pathophysiological grounds there is no basis for R, Westaby S. macroaggregation of platelets in plasma, as distinct connecting FFP with the platelet defect associated with from microaggregation in whole blood (and plasma), as determined using optical aggregometry and platelet counting respectively, is cardiopulmonary bypass. This we, among others, have specifically impaired following cardiopulmonary bypass in man. defined as the failure to form large stable aggregates Thromb Haemost 1994;72:511–518. (macroaggregation) while the formation of small aggregates [10] Belcher PR, Muriithi EW, Milne EM, Wanikiat P, Wheatley DJ, (microaggregation) is unaffected [9–11]. We have also Armstrong RA. Heparin, platelet aggregation, neutrophils and cardi- shown that this is a consequence of heparinisation and opulmonary bypass. Thromb Res 2000;98:249–256. [11] Kawahito K, Kobayashi E, Iwasa H, Misawa Y, Fuse K. Platelet that the influence of extracorporeal circulation is limited aggregation during cardiopulmonary bypass evaluated by a laser [12]. light-scattering method. Ann Thorac Surg 1999:79–84. Is it feasible? It certainly is and has been so for 35 years. [12] Muriithi EW, Belcher PR, Rao JN, Chaudhry MA, Nicol D, Wheatley DJ. The effect of heparin and extracorporeal circulation on platelet counts and platelet microaggregation during cardiopulmonary bypass. J Thorac Cardiovasc Surg 2000;120:538–543. * Corresponding author. E-mail address: pbelcher@clinmed.gla.ac.uk (P.R. Belcher). 1010-7940/01/$ - see front matter q 2001 Elsevier Science B.V. All rights reserved. PII: S 1 0 1 0 - 7940(01)0093 5-6

Journal

European Journal of Cardio-Thoracic SurgeryOxford University Press

Published: Nov 1, 2001

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