Avoidance of homologous transfusion in aortic operations: the role of autotransfusion, hemodilution, and surgical technique.

The transfusion requirement for 138 aortic reconstructive procedures was minimized through the combined use of hemodilution, autotransfusion, and surgical techniques reported to reduce operative blood loss. Elective procedures required an average of 1.65 U and ruptured aneurysms 9.63 U of homologous blood. Transfusion was avoided altogether in 42.6% of elective reconstructions and 8.3% of emergency procedures. Autotransfusion saved only 1.54 U for elective operations and 0.87 U for ruptured aneurysm, probably because of the effectiveness of hemodilution and specific surgical techniques that minimized dissection and consequent blood loss. Nonetheless, it proved to be cost effective, saving an average of $260 per patient in charges for homologous blood. The combined use of multiple blood conservation methods was shown to substantially reduce the need for homologous transfusion (compared to reported figures for blood use in aortic operations) and adds a measure of increased safety for the patient undergoing aortic operation.