Retrograde autologous priming RAP reduces deep hemodilution during cardiopulmonary bypass CPB

Saimir Kuci, Alfred Ibrahimi, Andi Kacani, Ermal Likaj, Altin Veshti, Selman Dumani, Klodian Krakulli, Ali Refatllari, Edvin Prifti


Immediate hemodilution and rapid decrease in osmotic pressure at the time of CBP onset are associated with the aforementioned organic dysfunctions.

Decreased osmotic pressure increases effective filtration pressure and microvascular filtration. Consequently, an increase in pulmonary interstitial fluid and myocardial edema is observed after discontinuation of CBP.

Retrograde autologous priming (RAP) is a means to effectively and safely restrict the hemodilution caused by the direct homologous blood transfusion and reduce the blood transfusion requirements during cardiac surgery.


Materials and Methods

The study included 40 patients scheduled to undergo coronary surgical revascularization, divided into two groups: the RAP group and the non-RAP group. The average age in both groups is 55 years (SD 5).



A significant benefit was observed between the two groups in the study regarding the amount of transfused blood (1.55 -SD 0.88) / (2.15 -SD 0.81). This is a very important fact in favor of using the RAP technique, taking into account the reduction of the risk for complications carried by heterologous transfusion. Also, a significant reduction in the use of donated blood at a time when the problems of blood insufficiency in the collection centers are known, is equally important.

The hospitalization (days of staying) in the ICU is also significantly lower in the RAP group (2.6 -SD 0.68) / (3.1-SD 0.64). This should be related to the faster activation of RAP in patients as a result of faster return to normal weight (with less fluid load), better ventilator function, and faster decline of cerebral edema.

Keywords: Retrograde autologous priming (RAP), hemodilution, cardiopulmonary bypassCPB)


DOI: 10.7176/ALST/81-04

Publication date: August 31st 2020

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