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[Heart surgery without blood transfusion]
E Ovrum1, E A Holen, M A Lindstein-Ringdal
1Hjertesenteret i Oslo.
Insights
Open heart surgery, specifically coronary artery bypass operations, can be safely performed without homologous blood transfusions. A strict blood conservation program achieved this in 100 consecutive patients.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Transfusion Medicine
Context:
- Blood conservation is crucial in open heart surgery to minimize risks like viral contamination and manage resource limitations.
- Coronary artery bypass grafting (CABG) traditionally involves significant blood product usage.
Purpose:
- To evaluate the feasibility and outcomes of performing elective CABG without homologous blood transfusions.
- To assess the efficacy of a comprehensive blood conservation protocol in a large patient cohort.
Summary:
- 100 consecutive CABG patients (13 female/87 male, aged 33-73) underwent surgery using a strict blood conservation program.
- The protocol included pre-operative autologous blood removal, retransfusion of heart-lung machine contents, and postoperative autotransfusion of mediastinal blood.
- No patients required homologous blood; all survived, were extubated rapidly (mean 1.6 hours), and did not need resternotomy for bleeding. Five patients received fresh frozen plasma for coagulopathy.
Impact:
- Demonstrates that elective CABG can be performed with minimal or no homologous blood transfusions, enhancing patient safety and resource management.
- Highlights the success of a multi-component blood conservation strategy in a real-world surgical setting.
- Provides evidence supporting the wider adoption of bloodless surgery techniques in cardiac procedures.
Abstract:
Blood conservation in open heart surgery has become mandatory in order to reduce the risk of viral contamination, and because of limited resources. We have performed 100 consecutive coronary artery bypass operations (13 women/87 men, aged 33-73 years, mean 58 years) without using homologous blood. A strict blood conservation programme was applied, with removal of autologous blood prebypass for retransfusion at the end of surgery, retransfusion of the heart-lung machine content to the patient, and autotransfusion of shed mediastinal blood in the postoperative period. All patients survived the operation and were extubated 1.6 hours (0-6) postoperatively. No patients needed resternotomy for bleeding, and no homologous blood was given. Five patients received 1-2 units of fresh frozen plasma because of coagulopathy. Mean hemoglobin was 12.0 g/100 ml and mean hematocrit was 36% at discharge from hospital. Elective coronary artery bypass surgery can be performed with little or no transfusions of homologous blood.