Strategies for repair of congenital heart defects in infants without the use of blood

Son, Jacques A.M. van; Hovaguimian, Hagop; Rao, Ivatury M.; He, Guo‐Wei; Meiling, Gregory A.; King, Douglas H.; Starr, Albert

doi:10.1016/0003-4975(94)00841-t

Cited by 39 publications

(14 citation statements)

References 8 publications

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“…However, a blood transfusion can potentially cause a variety of complications, such as an immunologic reaction that causes organ dysfunction and transmissions of pathogens [1,2]. To eliminate these risks, numerous blood management strategies were proposed to avoid homologous blood transfusions in congenital cardiac surgery, including miniaturized bypass systems, modified ultrafiltration, retrograde autologous priming, cell salvage, and autologous blood donation [3,[10][11][12]. Bloodless CPB strategies in infants are proposed but they have limited application, particularly in neonates with weight less than 4 kg [3].…”

Section: Discussionmentioning

confidence: 99%

Open cardiac surgery in the first hours of life using autologous umbilical cord blood☆

Fedevych¹,

Chasovskyi²,

Vorobiova³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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Section: Discussionmentioning

confidence: 99%

Open cardiac surgery in the first hours of life using autologous umbilical cord blood☆

Fedevych¹,

Chasovskyi²,

Vorobiova³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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“…He successfully treated 11 patients, each of whom weighed <10 kg (median weight 6.8 kg; minimum weight 3.2 kg; maximum weight 9.6 kg), without blood transfusion. Priming blood volume was reduced by decreasing the length and diameter of the circuit tubing and by eliminating the arterial filter (7). Vacuum-assisted venous drainage was introduced in pediatric surgery and proved efficient in decreasing homologous blood transfusion (8).…”

Section: Discussionmentioning

confidence: 99%

Blood Transfusion in Pediatric Cardiac Surgery

Durandy

2010

Artificial Organs

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The aim of the study is to measure the volume of homologous blood needed for one pediatric patient during his hospital stay. Over a 4-month period, all the patients operated upon with a blood prime or requiring blood transfusion during their hospital stay were included in this study.The cardiopulmonary bypass protocol associates a miniaturized bypass circuit, vacuum-assisted venous drainage, and microplegia. The volume of each blood product opened is known and the volume of blood product remaining, following the last transfusion, is measured. Data collected areas follows: patient weight; hemoglobin level before surgery,during bypass, and in intensive care after the last transfusion;time to extubation; and degree of inotropic support.Forty-six patients weighing 5.1 1.5 kg were included in this study. Cardiopulmonary bypass priming volume was 100 mL for patients up to 3.5 kg, 120 mL for patients between 3.6 and 7.5 kg, and 160 mL for patients between 7.6 and 8.6 kg. The volume of blood transfusion was 271 112 mL, hemoglobin level before surgery was 10.3 1.7 g/dL, hemoglobin level during surgery was 11.0 1.5 g/dL, and hemoglobin level after the last transfusion was 12.3 2.4 g/dL. Time to extubation was 12 3.3 h, and inotropic support was enoximone in 37 patients,whereas 6 patients needed enoximone and epinephrine.No patient needed reexploration for bleeding and one patient received a platelet transfusion.The mean blood transfusion volume was equivalent to 60% of the patient’s total blood volume (estimated to be 80 mL/kg).

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“…Efforts have been made to minimize the use of homologous blood in the pediatric population. 12,13) The miniaturized CPB system may allow transfusion-free heart surgery for small infants and children. 8) In our institution, we have developed a priming volume CPB system with the minimal volume of 140 mL.…”

Section: Discussionmentioning

confidence: 99%

The Influences of Red Blood Cell Transfusion on Perioperative Inflammatory Responses Using a Miniaturized Biocompatible Bypass With an Asanguineous Prime

et al. 2009

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SummaryWhole blood transfusion generates an inflammatory response and may contribute to organ dysfunction following cardiopulmonary bypass. We established a miniaturized (minimum 140 mL) and biocompatible bypass system to reduce perioperative inflammatory responses and avoid blood transfusions. This study was designed to reveal the influences of stored red blood cell (RBC) transfusions on perioperative inflammatory responses in infants.Fifty-four consecutive patients weighing 4-10 kg who underwent surgical procedures for complex heart anomalies with asanguineous prime were retrospectively reviewed. Twenty-two patients (40.7%) received RBC transfusions during CPB. The postoperative peak white blood cell count (p-WBC), peak neutrophil count (p-NC), and peak C-reactive protein (p-CRP) were compared for both patient groups. Stepwise multiple logistic regression analyses were used to investigate which of the factors most affected the perioperative inflammatory responses.The p-CRP and p-NC in patients with transfusion was significantly greater than those in patients without transfusion (CRP 8.1 ± 5.1 versus 5.5 ± 3.0 mg/dL, P < 0.05, p-NC 14.6 ± 4.5 versus 12.0 ± 4.0 × 1000/mm 3 , P < 0.05). Multivariate analyses showed that RBC transfusion most affected p-WBC (coefficient: 3.89, 95% confidence interval [CI] 0.79-6.99, P = 0.015) and p-NC (coefficient: 3.64, 95% CI 0.87-6.40, P = 0.011). The RBC transfusions increased the perioperative inflammatory responses, compared to transfusion-free procedures, even when using a miniaturized biocompatible bypass with an asanguineous prime. (Int Heart J 2009; 50: 581-589)

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Strategies for repair of congenital heart defects in infants without the use of blood

Cited by 39 publications

References 8 publications

Open cardiac surgery in the first hours of life using autologous umbilical cord blood☆

Open cardiac surgery in the first hours of life using autologous umbilical cord blood☆

Blood Transfusion in Pediatric Cardiac Surgery

The Influences of Red Blood Cell Transfusion on Perioperative Inflammatory Responses Using a Miniaturized Biocompatible Bypass With an Asanguineous Prime

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