ACUTE NORMOVOLEMIC HEMODILUTION IN CARDIAC SURGERY: STUDY QUESTIONS ITS EFFICACY IN REDUCING BLOOD TRANSFUSIONS

Large-scale international trial led by IRCCS Ospedale San Raffaele reveals no significant benefits.

A comprehensive international study led by IRCCS Ospedale San Raffaele in Milan has challenged the effectiveness of acute normovolemic hemodilution (ANH) in reducing the need for allogeneic blood transfusions during cardiac surgery involving cardiopulmonary bypass. Published in The New England Journal of Medicine, this multicenter, randomized trial involved 2,010 patients from 32 centers across 11 countries.

ANH involves withdrawing a portion of the patient’s blood shortly before surgery and replacing it with fluids to maintain blood volume. The hypothesis is that by diluting the blood, any blood loss during surgery would result in a smaller actual loss of red blood cells. However, the study found no significant difference in the number of patients requiring at least one transfusion: 27.3% in the ANH group compared to 29.2% in the control group.

Furthermore, there were no significant differences between the two groups regarding 30-day mortality, ischemic complications, acute kidney injury, or the need for reoperation due to bleeding. Interestingly, the ANH group had a slightly higher incidence of reintervention for bleeding (3.9%) compared to the control group (2.7%).

Dr. Fabrizio Monaco, lead author and Head of Cardiothoracic and Vascular Operating Rooms at IRCCS Ospedale San Raffaele, emphasized that these findings suggest ANH may not be as effective as previously thought in reducing transfusion requirements and could potentially be associated with an increased risk of reoperation due to bleeding. He advocates for a reevaluation of current practices and consideration of alternative strategies.

Professor Giovanni Landoni, study coordinator and Director of the Anesthesia and Intensive Care Research Center at IRCCS Ospedale San Raffaele, added that the results highlight the importance of evidence-based practices in clinical decision-making. He suggests focusing on other effective interventions, such as improving surgical hemostasis, utilizing point-of-care coagulation tests, and optimizing preoperative patient management.

The study was funded by the Italian Ministry of Health (grant RF-2018-12366749) and underscores the value of independent clinical research in guiding more efficient and effective healthcare practices.

Why This Matters for Medical Tourists:

  • Access to Cutting-Edge Research: Patients can benefit from treatments informed by the latest evidence-based studies.

  • Expert Care Teams: Treatment by a multidisciplinary team at a leading research hospital.

  • Personalized Treatment Plans: Tailored therapies based on individual patient profiles.

  • Advanced Technology: Utilization of state-of-the-art medical devices and techniques.

For international patients seeking advanced cardiac care, IRCCS Ospedale San Raffaele offers pioneering therapies and expert care. To learn more about the study and other treatment options, please contact the multidisciplinary team at .

References: Press release

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