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J Thorac Cardiovasc Surg 2011;142:875-881
© 2011 The American Association for Thoracic Surgery
Congenital Heart Disease |
a Department of Anesthesiology, German Heart Institute, Berlin, Germany
b Department of Cardiothoracic and Vascular Surgery, German Heart Institute, Berlin, Germany
c Institute of Transfusion Medicine, Charité, University Medicine Berlin, Berlin, Germany
d Department of Physiology, Charité, University Medicine Berlin, Berlin, Germany
Received for publication August 26, 2010; revisions received December 17, 2010; accepted for publication January 26, 2011. * Address for reprints: Helmut Habazettl, MD, PhD, Institute of Physiology, Thielallee 71, 14195 Berlin, Germany. (Email: helmut.habazettl{at}charite.de).
Objective: Owing to the mismatch between cardiopulomary bypass priming volume and infants’ blood volume, pediatric cardiac surgery is often associated with transfusion of homologous blood, which may increase the risk of perioperative complications. Here we report the impact of a very low volume (95-110 mL) cardiopulmonary bypass circuit during arterial switch operations in neonates with transposition of the great arteries on blood requirements, tissue oxygenation, and patient outcome.
Methods: Twenty-three consecutively treated neonates aged 2 to 17 days were treated with the blood-sparing approach. Asanguineous priming was used in all cases and packed red blood cells were added when hemoglobin concentration decreased below 7 g/dL. Cerebral and lower body tissue oxygenation was monitored by near-infrared spectroscopy. Intraoperative and postoperative transfusion, duration of ventilation and intensive care unit stay, wound infection, and 30-day mortality were assessed for patient outcome.
Results: Intraoperative blood transfusion was necessary in 6 of 23 neonates. An additional 11 neonates received postoperative blood transfusions on the intensive care unit, leaving 6 infants who received no blood at all. Preoperative hemoglobin concentration was the only predictor for intraoperative transfusion requirement (11.6 ± 0.9 and 13.3 ± 0.4 g/dL in infants with and without intraoperative transfusion, respectively). Despite marked differences in hemoglobin concentrations between infants with and without transfusion, regional tissue oxygenation increased in both groups during cardiopulmonary bypass and returned to baseline at the end of surgery. In-hospital patient outcome was similar in both groups.
Conclusions: Transfusion-free complex cardiac surgery can be achieved even in neonates without jeopardizing tissue oxygenation or patient safety.
This article has been cited by other articles:
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  M. Schweiger, H. Dave, J. Kelly, and M. Hubler Strategic and operational aspects of a transfusion-free neonatal arterial switch operation Interact CardioVasc Thorac Surg, June 1, 2013; 16(6): 890 - 891. [Abstract] [Full Text] [PDF]
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 M. Redlin, H. Habazettl, W. Boettcher, M. Kukucka, H. Schoenfeld, R. Hetzer, and M. Huebler Effects of a comprehensive blood-sparing approach using body weight-adjusted miniaturized cardiopulmonary bypass circuits on transfusion requirements in pediatric cardiac surgery J. Thorac. Cardiovasc. Surg., August 1, 2012; 144(2): 493 - 499. [Abstract] [Full Text] [PDF]
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 R. C. Eberhart and D. M. Meyer Invited Commentary Ann. Thorac. Surg., January 1, 2012; 93(1): 146 - 147. [Full Text] [PDF]
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