Microporous polysaccharide hemosphere absorbable hemostat use in cardiothoracic surgical procedures

Background: Topical hemostatic agents are used to reduce bleeding and transfusion need during cardiothoracic surgery. We report our experience with Arista^® AH Absorbable Hemostatic Particles (Arista^® AH), a novel plant-based microporous polysaccharide hemostatic powder. Methods: Data were retrospectively collected for patients (n=240) that received cardiothoracic surgery at our institution from January 2009 to January 2013 with (n=103) or without (n=137) the use of Arista® AH. Endpoints included protamine to skin closure time (hemostasis time), cardiopulmonary bypass time, quantity of Arista® AH applied, intraoperative blood product usage, intraoperative blood loss, chest tube output 48 hours postoperatively, blood products required 48hours postoperatively, length of stay in the intensive care unit, 30-day morbidity, and 30-day mortality. Results: 240 patients (176M: 64F) underwent 240 cardiothoracic procedures including heart transplantation (n=53), cardiac assist devices (n=113), coronary artery bypass grafts (n=20), valve procedures (n=19), lung transplantation (n=17), aortic dissection (n=8), and other (n=10). Application of Arista^® AH led to significant reduction in hemostasis time versus the untreated control group (Arista^® AH: 93.4±41min. vs. Control: 107.6±56min., p=0.02). Postoperative chest tube output in the first 48hours was also significantly reduced (Arista^® AH: 1594±949mL vs. Control: 2112± 1437mL, p<0.001), as well as transfusion of packed red blood cells (Arista^® AH: 2.4± 2.5 units vs. Control: 4.0±5.1 units, p<0.001). There was no significant difference in 30-day mortality or postoperative complications. Conclusion: Use of Arista^® AH in complex cardiothoracic surgery resulted in a significant reduction in hemostasis time, postoperative chest tube output, and need for postoperative blood transfusion.