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Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
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Transfusion free Norwood procedure.

Kevin Charette1, Amy Falconer-Harris1, Brian Perfette1

  • 1Seattle Children's Heart Center, Seattle Children's Hospital, Seattle, WA, USA.

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|November 20, 2025
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Summary

This study reports the first bloodless Norwood procedure for Hypoplastic Left Heart Syndrome, avoiding all exogenous blood products in neonates. This demonstrates a successful strategy for bloodless open-heart surgery in infants.

Keywords:
Norwood procedurebloodlesshemodilutionhypoplastic left heart syndromeminiaturized cardiopulmonary bypassmodified ultrafiltrationretrograde autologous primetransfusion freevenous autologous prime

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Area of Science:

  • Pediatric Cardiac Surgery
  • Neonatal Intensive Care
  • Transfusion Medicine

Background:

  • Exogenous blood products are commonly used in neonatal open-heart surgery.
  • Minimizing blood product use is crucial for reducing risks in neonates.
  • Our center has developed a protocol to limit blood product transfusions during cardiopulmonary bypass (CPB).

Purpose of the Study:

  • To describe a case of a bloodless Norwood procedure in a neonate with Hypoplastic Left Heart Syndrome.
  • To highlight the successful application of a bloodless surgical strategy in complex neonatal cardiac surgery.
  • To present a novel approach to neonatal cardiac surgery minimizing the need for blood products.

Main Methods:

  • Utilized miniaturized cardiopulmonary bypass (CPB) circuitry with shortened lines.
  • Employed minimized modified ultrafiltration and cardioplegia circuits.
  • Implemented low holdup volume vents and autologous CPB circuit priming.

Main Results:

  • The patient, diagnosed with Hypoplastic Left Heart Syndrome, underwent the Norwood procedure.
  • No exogenous blood products were administered during the entire hospitalization.
  • Adequate oxygen-carrying capacity was maintained throughout CPB initiation and the surgical procedure.

Conclusions:

  • Bloodless neonatal open-heart surgery, including the Norwood procedure, is achievable.
  • Miniaturized CPB techniques and autologous priming are effective in blood conservation.
  • This approach offers a viable alternative for neonates requiring complex cardiac surgery, reducing transfusion-related risks.