Cardiac surgery in adults and children without use of blood

Since 1968, following Cooley's and Zubiate's group presentation, our team has been using extracorporeal circulation (ECC) with hemodilution without use of blood for priming of the circuit. Progressively this technique, that was only reserved to the Jehovah's Witnesses, became routine. Whereas in 1980, 30% of the patients operated by our group had not received any blood products during their stay in hospital, in the last few years, 1987-95, more than 80% of the patients could benefit from this technique. So, out of 15,573 cardiac surgeries under ECC performed between 1972 and 97, 14,798 (95%) were done in auto-perfusion, and 314 to Jehovah's Witnesses. The results of this routine technique, not using blood, was analysed in the adult as well as the child. More precisely, 100 adults operated on consecutively in 1995 and 50 children of less than 15 kilos operated on in 1994 were closely examined clinically and biologically. In adults, biology was studied in the 90 patients who did not receive any blood, and showed, as already quoted in previous studies on identical or larger series, the following evolution of the different parameters: Hematocrit went from 41% in a pre-operative mean value to 33% at the 10th day, which is a decrease of 20%. Hemoglobin went from 14 gr to 11 gr, that is a decrease of 21%. Proteinemia which was at 73 gr pre-operatively decreased to 58 gr at the first day to reach 60 gr at the 10th day (decrease of 13%). In children, blood was necessary in 20 among 28 patients below 8 kg (group I), and no blood was used for the 22 patients above 8 kg (group II). Regarding the biological results, in the group I, hematocrit showed a decrease of 18% between the day before surgery and 1 day after. Hemoglobin a decrease of 17%, platelets a decrease of 56% and Protides 3%. Fibrine showed a decrease of 43% the day of surgery, and an increase of 15% at day 1; and the Prothrombine time finally decreased by 24%. The results are very similar in group II. In conclusion, cardiac surgery without any pre or post-operative use of blood is therefore possible, simply, without pre-donation or without any particular treatment in 90% of adults of all ages and pathologies, and in over 50% of children (78% if category is over 7 kg) and has satisfactory results.