The blood preservation in surgical treatment of the mitral disease of the heart
Objective. Investigation of modern possibilities of the bloodless technique of surgical treatment of the mitral valve failure (МVF) in environment of artificial blood circulation (ABC).
Маterials and methods. There were examined 727 patients, suffering MVF. All the patients were divided into two groups: the main and a comparative one. The main group have consisted of 637 patients, in whom various variants of the blood preservation without its transfusion were applied, without application of a cell-saver, hemoconcentrating columns and the blood ultrafiltration; and a comparative one group have consisted of 90 patients, to whom the blood preparations were transfused. The procedure depicted have provided the anesthesia and the perfusion measures during operation of the mitral valve change, including аs well the peculiarities of the intraoperative infusion therapy management in the ABC conditions.
Results. In the main group of patients the rate of postoperative infectious complications have constituted 1.2%, while in a comparative one - 9.9%. Median duration of stay on the artificial pulmonary ventilation have constituted (6.7 ± 2.3) and (12.3 ± 8.4) hours accordingly. The average duration of stay in reanimation department was (58.4 ± 12.4) and (116.3 ± 45.2) hours, accordingly (р < 0.05). The intraoperative blood loss volume in the main group was significantly lesser, than in a comparative one: (261.2 ± 33.8) and (533.1 ± 131.6) ml, accordingly (р < 0.05).
On all stages of the operation and in postoperative period the level of hemoglobin have persisted in a compensation period range, what constitutes a safe level of the blood oxygen capacity.
Conclusion. Introduction of intraoperative variants of the autologous blood reservation without application of the donor’s blood, сеll-saver and hemoconcentration columns is not accompanied with lowering of the oxygen delivery and consumption, as well as development of lactate-acidosis.
The improved procedure of anesthesiological support consisted of the infusion-transfusion therapy conduction with stimulation of diuresis, the water balance control, applying combination of an acute normovolemic hemodilution with ABC, and lowering of hemodilution due to retrograde filling of oxygenator by autologous blood. As well there were applied various methods of the autologous blood exfusion and its components combinations, change of tactics in the infusion hemostatic therapy; a central venous pressure control and support of median arterial pressure.
Introduction of the procedure depicted have guaranteed a good clinical effect without complications of transfusion on a hospital stage of the patients’ management.
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