Blood Conservation Strategies in Cardiac Surgery

Abstract

Perioperative bleeding in cardiac surgery is related to both surgical trauma of blood vessels and defects in the hemostatic mechanism caused, in part, by cardiopulmonary bypass. Blood transfusion therefore remains a significant risk of cardiac surgery with important health and economic consequences. Blood conservation strategies for cardiac surgery have advanced over the years and the following discussion will focus on the current practices at Toronto General Hospital.

Intraoperative tranexamic acid in pediatric bloodless cardiac surgery

“…These techniques involve a low priming volume CPB by downsizing the bypass circuit with the help of iron and erythropoietin administration, autologous blood donation, cell salvaging, and ultrafiltration. 3 The antifibrinolytic agent tranexamic acid (TXA) has been proved to substantially reduce perioperative blood loss and transfusion requirements in cardiac surgery. 4 TXA is a lysine analogue that prevents degradation of fibrin and dissolution of clots by inhibiting the activation of plasminogen.…”

Managing bleeding in cardiac surgery

“…As the name implies, these agents act by inhibiting the physiologic fibrinolytic pathway that is responsible for limiting and dissolving clots. The lysine analogous, aminocaproic acid (EACA), and tranexamic acid (TXA), act through interfering with the activation of plasminogen to plasmin and its binding to fibrin clots . Desmopressin (a long‐acting vasopressin agonist) is indicated to maintain hemostasis in patients with hemophilia A or mild to moderate type‐1 von Willebrand disease with Factor VIII activity of more than 5%.…”

Open-Chest Device Closure for the Minimally Invasive Management of Atrial Septal Defect in Young Children

“…The significant benefit offered by the open-chest device closure is the avoidance of CPB, thus maximally reducing the requirement of blood products. Blood transfusions remain a risk of cardiac surgery that have important health consequences [Karski 2003]. In our study, all the blood products in the surgical repair groups were required with CPB.…”