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Quantitative and qualitative assessment of intraoperative aspiration and reinfusion of autologous blood with the Solcotrans was carried out in 11 males (52-79 years) undergoing elective resection of abdominal aortic aneurysms. Hematology, blood chemistry, coagulation parameters and complement activation were studied in the patient's blood at the following time points: preoperatively, before and after heparinisation, after retransfusion of the first and last Solcotrans, 6 and 20 hours postoperatively. In addition the same quality control was performed in the first and last Solcotrans blood. Results (mean values of 11 patients +/- 1 SD): Intraoperatively 2-3 Solcotrans units were salvaged (total 1039 +/- 565 ml) of which 805 +/- 487 ml were retransfused to the patients. As a mean patients required only 1 unit of homologous RBC's (395 +/- 781 ml) intraoperatively. Patient's intraoperative hemoglobin concentration amounted to 10 g/dl or more. Whereas the hemoglobin level in the Solcotrans attained only 8.2 g/dl. Thrombocyte counts (48 +/- 18 x 10(9)/l) and ionized calcium (0.2 +/- 0.4 mmol/l) were significantly depressed when compared to the preoperative patient values (p < 0.05). The protein concentration remained within normal limits in the patient's and in the Solcotrans blood. Complement activation (C4a, C5a [des Arg]) showed a significant increase after initiation of surgery and there was no significant difference between the solco- or patient blood. Whereas plasma free hemoglobin, coagulation and fibrinolysis parameters showed a significant elevation in the Solcotrans blood. In conclusion the solcotrans system offers a fast, efficient and simple method for salvage and retransfusion of intraoperative autologous blood.

In a prospective randomized study 10 patients received their shed mediastinal blood after elective coronary artery bypass surgery and were compared to 10 control patients without retransfusion. The quality assessment can be summarized as follows (mean +/- 1 SD): 1. Hemoglobin concentration of the shed blood was 9.6 +/- 1.45 g/dl. 2. The energy rich phosphate compounds of the shed blood erythrocytes were 2.6 +/- 0.8 mumol/gHb ATP (70% of the patients preoperative value) and 14.8 +/- 4.2 mumol/gHb 2.3-DPG (normal). 3. Proteins, immunoglobulins and especially albumin in the shed blood were not significantly different from the patients own values. 4. No electrolyte changes, safe for a slight increase in potassium (5.7 +/- 0.7 mmol/l). 5. The activated clotting time of the patient did not change during retransfusion. 7. Plasma free hemoglobin was elevated to 211.1 +/- 44.3 mg/dl in the shed blood; however, no significant increase could be noted in the retransfused patients and no hemoglobinuria occurred. Postoperative retransfusion of shed mediastinal blood is a simple and safe method of autologous transfusion early after cardiac surgery and should be combined with other methods of blood salvage. The qualitative advantages of blood retransfusion consist in the absence of storage damage and in the preservation of autologous proteins and immunoglobulins.

Prosthetic vascular replacement materials are still suboptimal especially for distal peripheral and coronary bypass grafts due to the small caliber and high occlusion rates. Therefore new vascular grafts have been assessed with respect to blood compatibility, thrombogenicity and host pretreatment. In 12 heparinized minipigs (25 kg), a total of 120 small caliber grafts (i.d. 3.0 mm) were perfused (6 min) in a femoro-femoral arteriovenous shunt (AVS). Materials included: Dacron (Atrium), PTFE (Gore), Polyurethanes (PU), Auto- and Xenografts. Animals were treated preoperatively with fishoil (3 g EPA/QD x 3 weeks = group I), perioperatively with prostaglandins (PGE1 = group II) or with fishoil and graft incubation in plasma proteins (= group III) and compared to controls without pretreatment (= group 0). We measured flow, deposition of marked thrombocytes (HMPAO-Tc* per area and per weight). - Blood flow was similar in AVS for all groups and materials (168 +/- 86 ml/min, p = NS). There was no significant correlation in deposition of marked thrombocytes and host pretreatments (group 0: controls = 7356 counts/area, group I: fishoil = 6807. group II: PGE1 = 7864). However graft incubation in plasma proteins significantly lowered deposition of marked thrombocytes (1766 in group III vs. 7356 in group 0: p less than 0.05). And significant differences of thrombocyte counts where found between the different materials: Autografts less than PTFE less than Xenografts less than Small Pore PU less than Dacron less than Large Pore PU.--AVS is a useful tool to determine early thrombogenicity in prosthetic vascular replacement materials and to assess the effect of different host pretreatments.

The surface of the leaflets of orthotopic transplanted glutaraldehyd-conditioned conus-pulmonalis xenografts show when analysed by a scanning microscope the following constant changes. Within seconds the surface of the leaflets is covered by a grainy layer of proteins followed by fibrin threads. Cellular elements of the blood--like platelets, white blood cells, macrophages and microthrombi--are incorporated in the fibrin network. This leads, after several weeks to a fibrous layer especially over the stiff parts of the valve. No endothelium was seen even after 6 months.

Reduction of post-bypass-hemodilution by ultrafiltration was assessed. Five dogs were subjected to 1 hour of cardiopulmonary bypass and were hemodiluted with 2 liters of Ringer lactate solution to a hematocrit below 20%. An arterial hemofilter was then incorporated into the system and 1 liter of fluid was ultrafiltrated for 16 minutes during partial bypass. The filtrate was free of protein and hemoglobin. There was a significant increase of the hematocrit from 19 to 29%, and protein from 2,7 to 5,4 g%. No hemodynamic alterations were seen during or after filtration. Osmolality remained within normal limits (from 284 to 296 mOsm/kg). In addition, no electrolyte imbalance was found. The method is therefore safe for quick volume removal without the side effect of diuretics.