Blood Transfusions After Pediatric Cardiac Operations: A North American Multicenter Prospective Study

Mazine, Amine; Rached-d’Astous, Soha; Ducruet, Thiérry; Lacroix, Jacques; Poirier, Nancy

doi:10.1016/j.athoracsur.2015.04.033

Cited by 48 publications

(38 citation statements)

References 35 publications

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“…The primary transfusion threshold for red cells in paediatric cardiac surgery remains the Hb. The optimum Hb thresholds are not clear and there is variation in practice (Mazine et al , ).…”

Section: Cardiac Surgerymentioning

confidence: 99%

Guidelines on transfusion for fetuses, neonates and older children

et al. 2016

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“…The primary transfusion threshold for red cells in paediatric cardiac surgery remains the Hb. The optimum Hb thresholds are not clear and there is variation in practice (Mazine et al , ).…”

Section: Cardiac Surgerymentioning

confidence: 99%

Guidelines on transfusion for fetuses, neonates and older children

et al. 2016

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“…Ideal therapy is limited by an incomplete understanding of the sentinel events involved in declined lung function, including both the relevant soluble mediators and cognate receptors that are operational when the process is most likely to be reversible [ 1 , 10 , 11 ]. The earlier the lung injury be detected, the much more successful treatment will be done [ 3 , 8 , 12 ]. Therefore, discovery and validation of certain alarmin biomarker for CPB-related lung injury in infants and young children undergoing cardiac surgery would be of great help for early diagnosis and efficient therapeutic decision making.…”

Section: Introductionmentioning

confidence: 99%

Plasma levels of alarmin HNPs 1–3 associate with lung dysfunction after cardiac surgery in children

et al. 2017

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BackgroundEarly onset of lung injury is considerable common after cardiac surgery and is associated with increasing in morbidity and mortality, but current clinical predictors for the occurrence of this complication always have limited positive warning value. This study aimed to evaluate whether elevated plasma levels of human neutrophil peptides (HNPs) 1–3 herald impaired lung function in infants and young children after cardiac surgery necessitating cardiopulmonary bypass (CPB).MethodsConsecutive children younger than 3 years old who underwent cardiac surgery were prospectively enrolled. Plasma concentrations of HNPs 1–3 and inflammatory cytokines were measured before, and immediately after CPB, as well as at 1 h, 12 h, and 24 h after CPB.ResultsThirty patients were enrolled, 18 (60%) of whom were infants. Plasma levels of HNPs 1–3 and the pro-inflammatory cytokine interleukin-6 (IL-6) significantly increased immediately after CPB (P < 0.001), while IL-8 increased 1 h after the CPB operation (P = 0.002). The anti-inflammatory cytokine IL-10 levels were also significantly elevated immediately after CPB compared with the baseline (P < 0.001). The stepwise multiple linear regression analysis showed that the plasma HNPs 1–3 levels immediately after CPB was independent correlated with the declined lung function, as reflected by the PaO2/FiO2 ratio on the first 2 days after operation (for the first day: OR, −1.067, 95% CI, −0.548 to −1.574; P < 0.001; for the second day: OR, −0.667, 95% CI, −0.183 to −1.148; P = 0.009) and prolonged mechanical ventilation time (OR, 0.039, 95% CI, 0.005 to 0.056; P = 0.011). Plasma levels of HNPs 1–3 and IL-10 returned to the baseline values, while IL-6 and IL-8 levels remained significantly higher than baseline 24 h after CPB (P ≤ 0.01).ConclusionsElevated HNPs 1–3 levels immediately after CPB correlate with impaired lung function, and HNPs 1–3 could serve as a quantifiable early alarmin biomarker for onset of lung injury in infants and young children undergoing cardiac surgery with CPB.Electronic supplementary materialThe online version of this article (10.1186/s12890-017-0558-4) contains supplementary material, which is available to authorized users.

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“…There is a great variability in practice of blood transfusion for a given diagnostic code and complexity and pediatric population is no exception to the rule[9]. By far, pediatric patients undergoing cardiac surgery are exposed to more blood transfusion intra and post-operatively with no consensus or scientific evidence to what would be the optimal hematocrit level across different diagnosis and physiologic status[10-15]. …”

Section: Discussionmentioning

confidence: 99%

Blood conservation pediatric cardiac surgery in all ages and complexity levels

Karimi¹,

Sullivan²,

Linthicum³

et al. 2017

WJC

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AIMTo demonstrate the feasibility of blood conservation methods and practice across all ages and risk categories in congenital cardiac surgery.METHODSWe retrospectively analyzed a collected database of 356 patients who underwent cardiac surgery using cardiopulmonary bypass (CPB) from 2010-2015. The patients were grouped into blood conservation (n = 138) and non-conservation (n = 218) groups and sub-grouped based on their ages and procedural complexity scores.RESULTSThere were no statistical differences in gender, weight, pre-operative and pre-CPB hematocrit levels in both groups. Despite equivalent hematocrit levels during and after CPB for both groups, there was significantly less operative homologous blood utilized in blood conservation group across all ages and complexity levels.CONCLUSIONBlood conservation surgery can be performed in congenital patients needing cardiac surgery in all age groups and complexity categories. The above findings in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products justify blood conservation in congenital cardiac surgery.

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Blood Transfusions After Pediatric Cardiac Operations: A North American Multicenter Prospective Study

Cited by 48 publications

References 35 publications

Guidelines on transfusion for fetuses, neonates and older children

Guidelines on transfusion for fetuses, neonates and older children

Plasma levels of alarmin HNPs 1–3 associate with lung dysfunction after cardiac surgery in children

Blood conservation pediatric cardiac surgery in all ages and complexity levels

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