Impact of Miniaturization of Cardiopulmonary Bypass Circuit on Blood Transfusion Requirement in Neonatal Open-Heart Surgery

Abstract

This study was undertaken to determine the impact of miniaturization of a cardiopulmonary bypass (CPB) circuit on blood transfusion and hemodynamics in neonatal open-heart surgery. Neonates (n = 102) undergoing open-heart surgery between 2002 and 2006 were included and divided into three groups: group 1 (n = 28), Dideco 902 oxygenator + 5/16" line; group 2 (n = 29), Dideco 901 oxygenator + 1/4" line; group3 (n = 45), Dideco 901 oxygenator + 3/16" arterial + 1/4" venous line. Amount of priming volume, blood and bicarbonate sodium use during CPB, and hemodynamics were compared. Priming volume in the groups 2 and 3 was significantly less compared with the group 1 (group 1, 575 +/- 37 ml; group 2, 328 +/- 12 ml, group 3, 326 +/- 5 ml, p < 0.05). Blood transfusion and bicarbonate sodium use during CPB in groups 2 and 3 were significantly less compared with group 1. Hemodynamics during CPB was comparable. There were no differences between groups 2 and 3 in any parameter. Miniaturization of the CPB circuit resulted in decrease in priming volume and subsequent reduction in blood and bicarbonate sodium use. Downsizing the lines had minimal impact on any of the parameters studied, and further efforts should be made to achieve neonatal open-heart surgery without blood transfusion.

Single Center Experience With a Low Volume Priming Cardiopulmonary Bypass Circuit for Preventing Blood Transfusion in Infants and Small Children

“…Previously, our report regarding with clinical neonatal open-heart surgery showed that decreased blood transfusion ameliorated metabolic acidosis during CPB and subsequent quick recovery in intensive care. 8 Although inflammatory markers, duration of ventilation or intensive care, and long-term neurological outcome were not evaluated in this study, we believe that elimination of blood transfusion has surely potential advantages in amelioration of inflammatory response and clinically quick recovery from surgery and hence, further investigation should be designed.…”

“…[1][2][3][4] To address these adverse effects of blood transfusion, various efforts have attempted in previous experimental and clinical studies. [5][6][7][8][9] Karamlou et al 5 showed that asanguineous blood priming reduced neutrophil-mediated organ dysfunction by using nonblood priming miniaturized CPB circuit in neonatal pig model. Previously, our report regarding with clinical neonatal open-heart surgery showed that decreased blood transfusion ameliorated metabolic acidosis during CPB and subsequent quick recovery in intensive care.…”

“…7 We also have attempted to achieve blood transfusion-free open-heart surgery by using our miniaturized CPB circuit in current era. 8 Our previous study showed the miniaturization of the CPB circuit ameliorated metabolic acidosis, decreasing the blood use, and subsequently improved clinical outcome including recovery in neonatal open-heart surgery. In this article, we retrospectively analyzed our current practice of blood transfusion-free openheart surgery in children weighing 5-20 kg.…”

“…[5][6][7][8][9] As a result, blood transfusion-free open-heart surgery was achieved without any neurological complication in 73% of ventricular septal defect (VSD) patients weighing Ͻ5 kg by using a miniaturized circuit. 7 We also have attempted to achieve blood transfusion-free open-heart surgery by using our miniaturized CPB circuit in current era.…”

The Aachen Miniaturized Heart‐Lung Machine—First Results in a Small Animal Model

“…Using an HLM with a low priming volume and a downsized foreign material surface will reduce inflammatory reactions and foreign blood donation, most likely yielding a better outcome (10). Downsizing of individual components alone may reduce the risk of complications (11), but this downsizing has physical limits, for example, the required heat and gas exchange surfaces or the minimal operating level in the venous reservoir (4). Searching for an advanced solution, we pursued a different approach.…”