• Britt Hofmann, Claudia Kaufmann, Markus Stiller, Thomas Neitzel, Andreas Wienke, Rolf-Edgar Silber, and Hendrik Treede.
• Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120, Halle, Germany. britt.hofmann@uk-halle.de.
• J Cardiothorac Surg. 2018 May 21; 13 (1): 50.

BackgroundAdult cardiac surgery with extracorporeal circulation is known to be associated with increased risk of blood transfusion leading to adverse outcomes. Procedures like retrograde autologous priming (RAP) may reduce these negative side effects. This randomized prospective study was initiated to assess whether RAP using specifically designed RAP bag (Terumo) has immediate effects on patient outcome.MethodsOne hundred eighteen adults undergoing elective CABG or elective aortic valve replacement were randomly assigned by a computer program into two groups: the RAP group (n = 54) in which the retrograde autologous priming was applied and the non-RAP (n = 64) group in which the same setting was used without the possibility to save priming volume. Patient demographics, preoperative characteristics and postoperative outcomes were analyzed for both groups.ResultsThe primary endpoint defined as rate of intraoperative blood transfusion was significantly reduced in the RAP-group (p = 0.04). The absolute risk reduction for RAP managed patients was 13.5 percent points. There were no significant differences in operation time and blood loss. No deaths and no myocardial infarctions were observed. The number of patients needed to treat to prevent at least one red blood cell transfusion was around 8 (NNT = 7.42).ConclusionsRetrograde autologous priming is a safe and less invasive procedure which achieves clear benefits for adult cardiac surgery patients. In the light of increasing red blood cell transfusion risks and costs and the wish of patients to avoid a transfusion implementation of retrograde autologous priming is an interesting option.Trial RegistrationGerman Clinical Trials Register ID: DRKS00013512 , registered 04 December 2017.

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