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Bloodless open heart surgery: simple and safe
Patrícia Paiva1, Eduardo Ferreira, Manuel Antunes
1Centro de Cirurgia Cardiotorácica Hospitais da Universidade de Coimbra, Coimbra, Portugal.
Insights
This study shows a blood-sparing policy in cardiac surgery is effective, with over 77% of patients avoiding blood products. This approach leads to low mortality and morbidity rates, demonstrating its safety and efficacy.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
Background:
- Blood product use is standard in cardiac surgery but linked to complications.
- Minimizing blood product use is a key goal in patient management.
Purpose of the Study:
- To evaluate the outcomes of a policy aimed at minimizing blood product usage in cardiac surgery.
- To assess the safety and effectiveness of a blood-sparing strategy.
Main Methods:
- Retrospective review of 1505 adult patients undergoing coronary or valve surgery with cardiopulmonary bypass (CPB).
- Implementation of a bloodless prime for CPB circuits when hematocrit (Hct) was ≥36%, minimizing prime volume.
- Use of plasma for coagulation deficiencies and reinfusion of all remaining blood and shed mediastinal blood.
Main Results:
- Operative mortality was low (0.7% for coronary, 0.5% for valve).
- 77.3% of patients did not require blood or blood products (88.7% of coronary, 66.5% of valve).
- Mean Hct remained stable post-CPB (28.9% initiation, 28.8% discontinuation); reoperation for bleeding was 2.4%.
Conclusions:
- The implemented blood-sparing policy is simple, effective, and safe.
- This strategy significantly reduces the need for blood and blood products in cardiac surgery patients.
- Further measures can be explored to further decrease blood product utilization.
Objectives:
The use of blood or blood products is routine in cardiac surgery, but is associated with various complications. Aware of this, we have always tried to avoid the use of blood products whenever possible. In this study we sought to evaluate the results of this policy.
Methods:
The records of 1505 adult patients who underwent coronary (732) or valve (773) surgery under cardiopulmonary bypass (CPB) in 2002 and 2003 were reviewed retrospectively. Of these, 1058 were male (70.3%) and the mean age was 62.1+/-11.4 years. Mean weight was 68.5+/-10.2 kg and body surface area was 1.7+/-0.2 m2, corresponding to a blood volume of 4119.9+/-593.6 ml. Preoperative hematocrit (Hct) was 40.6+/-4.2% and the prothrombin index was 87.0+/-17.4%. A bloodless prime of the bypass circuit was used for all patients with Hct > or =36%. The prime volume was reduced to the minimum possible. Plasma was used when coagulation was deficient. All blood remaining in the CPB circuit was reinfused at the end of the procedure, either in the operating room or in the ICU. Shed mediastinal blood was retransfused in the first 6 hours in the ICU.
Results:
Operative mortality was 0.7% for coronary and 0.5% for valve patients. Blood or blood products were not used in 77.3% of the patients (88.7% of coronary and 66.5% of valve patients). Blood and/or plasma was initially added to the prime in 18.2% of cases and during CPB in 11%. Hct was 28.9+/-4.0% after initiation and 28.8+/-3.9% after discontinuation of CPB. The number of units (300 cc) of blood used was 0.25.57 per patient (1.09+/-0.73 per patient transfused). The number of units (300 cc) of plasma used was 0.24+/-0.72. Reoperation for bleeding was required in 2.4% of the patients.
Conclusions:
This blood-sparing policy is simple, effective and safe, resulting in low mortality and morbidity rates. More than three quarters of the patients did not require blood or blood products. Additional measures are possible to further decrease the use of blood products.
