Total bloodless open heart surgery in the pediatric age group

Forty-eight pediatric open heart surgical procedures were performed with bloodless techniques regardless of surgical complexity or presence of cyanosis at the Children's Hospital of Buffalo. Priming solution for cardiopulmonary bypass was reduced to avoid excessive hemodilution, and careful surgical techniques were used to minimize blood loss. Hypothermia compensated for decreased oxygen-carrying capacity and made it possible to reduce bypass flow safely. Tissue perfusion and oxygenation on bypass appeared comparable to or better than those in a control group that underwent open heart surgery with milder degrees of hemodilution. All patients tolerated bypass uneventfully without transfusion. Platelet counts were higher and blood loss less marked than those in the control group. Prevention of excessive dilution by priming solution seemed most important for preservation of platelets and subsequent hemostasis. Four of the smaller infants with complex cyanotic defects needed postoperative transfusion, while 44 patients did not receive transfusion at all during their hospital stay. Total blood product requirement was reduced from 11.5 to 0.35 units per patient. Intracardiac surgery without transfusion is possible in most pediatric patients without evidence of increased risk.