Cell saver elite

The patient was placed in the supine position with a wedge under the right chest. The femoral artery and vein were cannulated to establish CPB. After incision at the fourth intercostal space and pericardium traction, CPB commenced. The priming solution contained 1,500 mL Lactated Ringer’s injection, 500 mL Gelofusine, and 100 mL of 20% albumin. A target body temperature of 32 °C and non-pulsating perfusion utilizing a roller pump was adopted.
Furthermore, α state was used for blood gas management. After aortic clamping and antegrade perfusion of blood-containing del Nido cardioplegia (8 (link)), surgery was performed through the interatrial groove or the right atrial incision. After rewarming, norepinephrine, dobutamine, and milrinone were transfused to assist weaning from CPB if necessary. Conventional ultrafiltration was performed during CPB with a target amount of priming fluid, cardioplegia, and surgical rinsing saline. Residual blood in the surgical field and circuit were collected in an autotransfusion system (Cell Saver Elite; Haemonetics). After the hemostasis was completed, a chest tube was placed, and the incision was closed.

All medications acting on the renin-angiotensin system and all diuretics were stopped on the day before surgery. General anesthesia was induced according to the protocols of the Anesthesiology Department. Anesthesia was induced and maintained in patients using target-controlled infusions of sufentanil and propofol. Atracurium was used for all anesthetics. Hemodynamic parameters were monitored with a radial artery catheter on a Philips Intellivue® MX 800. Tranexamic acid was injected before and after CPB. The CPB target flow rate was calculated using the following equation: flow (l/min) = 2.6 × body surface area. Heparin was infused before and during CPB to achieve and maintain an activated clotting time > 400 s. The protamine dose was calculated at a 1:1 rate of the heparin dose and infused at the end of CPB. Cardioplegia was applied at the surgeon's discretion. Lost blood was recovered using Cell Saver® Elite® (Haemonetics™, France) and re-transfused when possible. Vasotropic or inotropic agents, fluids and transfusion products were administered at the discretion of the anesthesiologist based on clinical, echocardiographic and biological findings. After surgery, all patients were transferred to the cardiovascular intensive care unit (ICU).