Bloodless cardiac surgery utilizing a new low-prime oxygenator
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This study demonstrates a successful protocol to reduce homologous blood use in open-heart surgery. The method achieved significant blood savings without complications, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Homologous blood transfusions carry risks and increase healthcare costs.
- Minimizing allogeneic blood use in cardiac surgery is a significant clinical goal.
Purpose of the Study:
- To evaluate a prospective protocol for reducing homologous blood utilization during open-heart surgery.
- To assess the safety and efficacy of the protocol in a diverse patient cohort.
Main Methods:
- Implementation of a protocol focusing on surgical hemostasis, normovolemic hemodilution, and intraoperative blood salvage.
- Utilization of the Bentley BOS-10 Spiraflo oxygenator.
- Prospective enrollment of 100 consecutive open-heart surgery patients.
Main Results:
- All patients were successfully weaned from cardiopulmonary bypass without requiring blood transfusions.
- 80 patients completed surgery, and 60 were discharged from the ICU without homologous blood or derivatives.
- Mean blood usage was 1.32 units/patient, including reoperations for bleeding, with no significant complications.
Conclusions:
- The developed protocol effectively minimizes homologous blood requirements in open-heart surgery.
- The strategy is safe and feasible across various cardiac surgical procedures.
- This approach offers a viable alternative to routine blood transfusions, enhancing patient safety and resource management.
Abstract:
One hundred consecutive patients undergoing open-heart surgery were subjected to a prospective protocol designed for reduction of homologous blood utilization. The main points of this protocol were careful surgical hemostasis, normovolemic hemodilution, and retransfusion of blood lost to the operating field. It included use of the new Bentley BOS-10 Spiraflo oxygenator (Bentley Laboratories, Inc., Irvine, California, U.S.A.). The patients' ages ranged from 6 to 68 years and their weights from 18 to 84 kg. Fifty-four patients were subjected to valvular surgery, 30 to coronary revascularization, 13 to congenital defects repair, and 3 to resection of atrial myxomas. All patients could be weaned from bypass without receiving any blood. Eighty patients completed their surgery, and 60 were discharged from the intensive care unit without receiving any homologous blood or its derivatives. Total blood usage for the series throughout the entire stay in hospital was 1.32 units/patient, which included six reoperations for excessive bleeding. This reduction in blood utilization was achieved without excessive hemodilution and did not produce significant complications.