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The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 623-629, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Use of sufficient hemodilution to prevent coagulopathies following surgical correction of cyanotic heart disease

JD Milam, SF Austin, MR Nihill, AS Keats and DA Cooley

During surgical correction of cyanotic heart disease with associated polycythemia, sufficient reduction of hemoglobin and hematocrit values has proved effective in preventing postoperative coagulopathies. Three groups of surgical patients were studied: Group I--a control group consisting of 75 adults undergoing uncomplicated correction of acquired heart disease and requiring no blood or blood component transfusion; Group II--15 patients with tetralogy of Fallot whose intraoperative hemoglobin values remained above 10 gm/dl with conventional hemodilution techniques; and Group III--21 cyanotic surgical patients whose intraoperative hemoglobin values were lowered to less than 10 gm/dl with sufficient hemodilution. Group III was further broken down into a subgroup of six patients (Group IIIa) who underwent sequential laboratory determinations, as in Group I. In Group IIIa, postoperative coagulation function tests were only slightly more abnormal than in the nonpolycythemic control group (Group I). Patients in Group III (who had ample hemodilution) experienced 45% less bleeding and required 54% fewer blood components than those in Group II (who underwent conventional hemodilution).

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