Heart retransplantation in children without the use of blood product

Santos, Antônio Alceu dos; Silva, José Pedro da; Fonseca, Luciana da; Baumgratz, José Francisco

doi:10.5935/1678-9741.20120051

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…It is possible to reduce blood consumption by changing the transfusional practice. When you have the purpose and/or the multidisciplinary willingness (surgeons, physicians, anesthesiologist, and intensive care physicians) to manage and conserve the autologous blood, it is possible to perform complex cardiac surgeries, such as a cardiac retransplantation, without the use of allogeneic blood transfusion [ 28 ] . Worldwide medical centers seek to establish protocols to ration the use of blood and it has become a hospital's quality criteria to be pursued by the quality certifying agencies, such as the Joint Commission International [ 29 ] .…”

Section: Discussionmentioning

confidence: 99%

Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft

Santos¹,

Sousa²,

Piotto³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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IntroductionTransfusions of one or more packed red blood cells is a widely strategy used in cardiac surgery, even after several evidences of increased morbidity and mortality. The world's blood shortage is also already evident. ObjectiveTo assess whether the risk of mortality is dose-de>pendent on the number of packed red blood cells transfused after coronary artery bypass graft. MethodsBetween June 2009 and July 2010, were analyzed 3010 patients: transfused and non-transfused. Transfused patients were divided into six groups according to the number of packed red blood cells received: one, two, three, four, five, six or more units, then we assess the mortality risk in each group after a year of coronary artery bypass graft. To calculate the odds ratio was used the multivariate logistic regression model. ResultsThe increasing number of allogeneic packed red blood cells transfused results in an increasing risk of mortality, highlighting a dose-dependent relation. The odds ratio values increase with the increased number of packed red blood cells transfused. The death's gross odds ratio was 1.42 (P=0.165), 1.94 (P=0.005), 4.17; 4.22, 8.70, 33.33 (P<0.001) and the adjusted death's odds ratio was 1.22 (P=0.43), 1.52 (P=0.08); 2.85; 2.86; 4.91 and 17.61 (P<0.001), as they received one, two, three, four, five, six or more packed red blood cells, respectively. ConclusionThe mortality risk is directly proportional to the number of packed red blood cells transfused in coronary artery bypass graft. The greater the amount of allogeneic blood transfused the greater the risk of mortality. The current transfusion practice needs to be reevaluated.

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Section: Discussionmentioning

confidence: 99%

Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft

Santos¹,

Sousa²,

Piotto³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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“…The ANH, besides being cost-effective, has been safely used in avoiding or reducing homologous blood transfusions in adult [ 16 , 53 ] and pediatric [ 54 ] cardiac surgeries.…”

Section: Resultsmentioning

confidence: 99%

“…Since this strategy is easy to be applied, some authors defend its use in all patients undergoing cardiac surgery with CPB, regardless of the expected surgical blood loss [ 55 ] . This is an important strategy for serious and complex pediatric cardiac surgery [ 54 ] .…”

Section: Resultsmentioning

confidence: 99%

“…It is important to raise awareness of the main therapeutic possibilities to transfusions in order to economize the already scarce hemocomponent supply of blood banks. When there is multiprofessional purpose and involvement in managing and conserving autologous blood, complex cardiac surgeries such as cardiac retransplantation can be performed without the use of allogeneic blood [ 54 ] .…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic Options to Minimize Allogeneic Blood Transfusions and Their Adverse Effects in Cardiac Surgery: A Systematic Review

Santos¹,

Silva²,

Silva³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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IntrodutionAllogeneic blood is an exhaustible therapeutic resource. New evidence indicates that blood consumption is excessive and that donations have decreased, resulting in reduced blood supplies worldwide. Blood transfusions are associated with increased morbidity and mortality, as well as higher hospital costs. This makes it necessary to seek out new treatment options. Such options exist but are still virtually unknown and are rarely utilized.ObjectiveTo gather and describe in a systematic, objective, and practical way all clinical and surgical strategies as effective therapeutic options to minimize or avoid allogeneic blood transfusions and their adverse effects in surgical cardiac patients.MethodsA bibliographic search was conducted using the MeSH term “Blood Transfusion” and the terms “Cardiac Surgery” and “Blood Management.” Studies with titles not directly related to this research or that did not contain information related to it in their abstracts as well as older studies reporting on the same strategies were not included.ResultsTreating anemia and thrombocytopenia, suspending anticoagulants and antiplatelet agents, reducing routine phlebotomies, utilizing less traumatic surgical techniques with moderate hypothermia and hypotension, meticulous hemostasis, use of topical and systemic hemostatic agents, acute normovolemic hemodilution, cell salvage, anemia tolerance (supplementary oxygen and normothermia), as well as various other therapeutic options have proved to be effective strategies for reducing allogeneic blood transfusions.ConclusionThere are a number of clinical and surgical strategies that can be used to optimize erythrocyte mass and coagulation status, minimize blood loss, and improve anemia tolerance. In order to decrease the consumption of blood components, diminish morbidity and mortality, and reduce hospital costs, these treatment strategies should be incorporated into medical practice worldwide.

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“…Improvement in symptoms such as effort dyspnea and edema after transplantation makes the parents see their children's health as adequate because of the increase in survival rate and improvements in the quality of life of these children, who carry complex heart diseases and cardiomyopathies that do not respond to standard treatment (20) .…”

Section: Discussionmentioning

confidence: 99%

Mothers' perceptions of care practices for children who underwent heart transplantation

Feitoza

Rebouças

Silva

et al. 2016

Rev. esc. enferm. USP

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Objective:To learn mothers' perceptions of the main care practices that are to be administered after their children's heart transplantation, as well as the main difficulties they experience. Method: A descriptive qualitative study conducted in March and April 2014, using the focus group technique for data gathering. Participants were 12 mothers who were monitoring their children in a hospital that is a reference for treating cardiopulmonary diseases. Speeches were recorded, transcribed, and organized around the care practices that the mothers performed after the children's heart transplantations, the mothers' main difficulties, their perceptions of their children's quality of life, and the use of educational materials to disseminate post-transplantation care practices. For data analysis, we used the content analysis technique. Results: The following were clarified: the schedule of immunosuppressive medication; food, environmental, and bodily and oral hygiene; the use of surgical masks; and keeping the children away from crowds. Conclusion:The study contributed to the situational diagnosis of the care administered by the mothers of transplanted children.

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Heart retransplantation in children without the use of blood product

Cited by 4 publications

References 27 publications

Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft

Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft

Therapeutic Options to Minimize Allogeneic Blood Transfusions and Their Adverse Effects in Cardiac Surgery: A Systematic Review

Mothers' perceptions of care practices for children who underwent heart transplantation

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