J Thorac Cardiovasc Surg 2005;129:1201-1202
© 2005 The American Association for Thoracic Surgery
Reply to the Editor
Yoshio Ootaki, MD, PhDa,
Masahiro Yamaguchi, MD, PhDb,
Naoki Yoshimura, MD, PhDb
a Department of Biomedical Engineering Lerner Research Institute The Cleveland Clinic Foundation Cleveland, OH 44195
b Department of Cardiothoracic Surgery Kobe Children’s Hospital Kobe, Japan
We would like to thank Dr Jonas for his comments on our recent article.1 Our study was a prospective, observational study, and the patients had an uncomplicated course in which the criteria for red blood cell transfusion included anemia with a hematocrit level of less than 15% during bypass and 20% after bypass. Jonas and associates2 conducted a randomized study, and they concluded that a higher hematocrit strategy was safe for psychomotor development in infants. Habib and associates3 retrospectively analyzed the surgical outcomes from their 6-year experience and concluded that there was a strong association between severity of hemodilution during cardiopulmonary bypass and serious complications, particularly when the nadir hematocrit decreased to less than 22%.
In these 3 studies, the age, weight, seriousness of the disease, previous cerebrovascular accident, duration of circulatory arrest, and percentage of emergency surgery were completely different. Therefore, it might be very difficult to compare the results and determine an appropriate hematocrit level during cardiopulmonary bypass, especially for surgical cases using deep hypothermic circulatory arrest. Regarding the backgrounds of the patients, our study group was considered to be the best candidates for hemodilution during cardiopulmonary bypass. Transfusion has been proven to be an effective therapy for hemodilutional anemia. However, this therapy may cause severe adverse effects. Although there were no adverse effects in our study group, we agree with Dr Jonas that a prospective randomized study should be performed not only in adults, but also in children with simple congenital heart defects to determine the appropriate hematocrit level that improves a patient’s chance for the most favorable outcome.
References
- Ootaki Y, Yamaguchi M, Yoshimura N, Oka S, Yoshida M, Hasegawa T. Efficacy of a criterion-driven transfusion protocol in patients having pediatric cardiac surgery. J Thorac Cardiovasc Surg 2004;127:953-958.[Abstract/Free Full Text]
- Jonas RA, Wypij D, Roth SJ, Bellinger DC, Visconti KJ, du Plessis AJ, et al. The influence of hemodilution on outcome after hypothermic cardiopulmonary bypass. results of a randomized trial in infants. J Thorac Cardiovasc Surg 2003;126:1765-1774.[Abstract/Free Full Text]
- Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult. should current practice be changed?. J Thorac Cardiovasc Surg 2003;125:1438-1450.[Abstract/Free Full Text]
