Haematic Antegrade Repriming procedure to initiate a safer cardiopulmonary bypass.

Summary:

Background: 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 (RAP) 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 (HAR) offers a standardized materials and methodology that could offer a reproducible method inspired in evidence-based recommendations. Description of the technique: HAR is performed in a standardized Class IV MiECC that is reprimed antegradely with autologous blood obtained from the aorta of the patient, before the cardiopulmonary bypass (CPB) initiation. Then, CPB is started with the support of vacuum assisted venous drainage (VAVD). Discussion: The strict application of HAR results in a fix haemodilution of 300ml of crystalloid priming, avoiding the sudden haemodilution and the crystalloid embolism of the CPB initiation. The synergic effect that converges in HAR could exceed the evidence-based benefits of RAP, MiECC and VAVD promising to improve the outcomes in terms of transfusion, complications, stay and survival. Conclusion: HAR is proposed as a new approach to increase the safety of the CPB. Its overall benefits should be properly assessed and validated by current and further studies.