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Bloodless open-heart surgery in infants and children
V T Tsang1, R J Mullaly, P G Ragg
1Victorian Paediatric Cardiac Surgical Unit, Royal Children's Hospital, Parkville, Australia.
Insights
This study demonstrates the safety of open-heart surgery for pediatric congenital heart defects without blood transfusions. Meticulous surgical and perfusion techniques ensure successful outcomes for young patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Transfusion-Free Medicine
Background:
- Congenital heart defects are common in children.
- Jehovah's Witnesses' religious beliefs prohibit blood transfusions.
- Open-heart surgery for complex congenital defects often requires blood products.
Purpose of the Study:
- To evaluate the feasibility and safety of open-heart surgery without blood transfusions in pediatric patients.
- To assess outcomes in children undergoing cardiopulmonary bypass (CPB) for congenital heart defects, adhering to transfusion-free protocols.
Main Methods:
- Seven pediatric patients (3 months–6.5 years) with congenital heart defects underwent open-heart surgery.
- Hypothermic cardiopulmonary bypass (CPB) with crystalloid priming was utilized.
- All procedures were performed without blood or blood product administration.
Main Results:
- No hospital mortality was observed in the seven patients.
- Mean hospital stay was 10 days.
- Postoperative hematocrit levels showed progressive recovery, reaching 32.3% at discharge.
Conclusions:
- Complex open-heart surgery, including in small infants, can be safely performed without blood transfusions.
- Successful outcomes depend on meticulous surgical technique, perfusion management, and postoperative care.
- This approach offers a viable option for pediatric patients with religious or other objections to blood products.
Abstract:
Between October 1984 and January 1993, seven children of Jehovah's Witnesses underwent corrective open-heart surgery for congenital defects, on cardiopulmonary bypass (CPB). Age at surgery ranged from three months to 6.5 years, and weight ranged from 4.2 kg to 23.2 kg, with two children weighing less than 10 kg. The principal cardiac anomalies were tetralogy of Fallot (two), double outlet right ventricle (one), subaortic stenosis (one), transposition of the great arteries and ventricular septal defect (one), atrial septal defect and congenital heart block (one), and congenital mitral regurgitation (one). Hypothermic CPB was used in all seven operations with crystalloid priming of the extracorporeal circuit. CPB was based on our standard perfusion protocols. All surgical procedures were done without the use of blood or blood products. The mean preoperative haematocrit (Hct) was 40.9% (range 31.0-47.8%). The mean lowest intraoperative Hct was 17.3% (range 15.0-24.3%), whereas the immediate post-CPB Hct was 19.6% (range 15.3-24.0%). The Hct progressively increased to 29.2% (range 21.0-34.2%) on the first postoperative day, and 32.3% (range 24.2-38.3%) at the time of discharge. There was no hospital mortality, and the mean hospital stay was 10 days (8-13 days). We report the safe repair of complex open-heart surgery in children, without blood transfusion, even in small infants. The successful management of these patients requires meticulous attention to surgical and perfusion technique, and sound postoperative management.