Intraoperative tranexamic acid in pediatric bloodless cardiac surgery

Abstract

Intraoperative tranexamic acid administration was effective for blood conservation, and improved postoperative clinical outcomes in pediatric bloodless cardiac surgery.

Comparison Between Intravenous Boluses Versus Infusion of Tranexamic Acid (TXA) To Reduce Bleeding In Paediatric Cyanotic Congenital Heart Disease (CHD) Surgeries

“…20 In a retrospective study Hasegawa and colleagues evaluated the effectiveness of intraoperative TXA in blood-less cardiac surgery in children and found that intraoperative TXA was effective for both blood conservation and post-op clinical outcomes. 21 In another study, Patel and colleagues studied to determine the effectiveness of Topical TXA in paediatric cardiac surgery. They concluded that the combination of low dose systemic TXA and topical TXA intrapericadially before chest closure was the best.…”

Audit of transfusion of blood products in paediatric congenital heart surgery on cardiopulmonary bypass

“…Bloodless paediatric cardiac surgery has been performed successfully with the use of miniature circuits. 13,14,18,22 At our institution, miniature CPB circuits were not utilised at the time of the audit. Perhaps this was the reason for only 1.9% of cardiac surgical cases having bloodless surgery in our study.…”

“…11 The implementation of blood-conservation strategies to reduce rates of transfusion of blood products in paediatric cardiac surgery is recognised by the WHO. 12 These strategies have made it possible to perform bloodless paediatric cardiac surgery on CPB, 13 and have also been used successfully in Jehovah's Witness patients. 14,15 Blood-transfusion guidelines are available for adult cardiac surgery patients, 16 but could not be found for paediatric patients.…”

“…6 There are controversies regarding the safest haemoglobin level on CPB in paediatric cardiac surgery. 13,[17][18][19] A randomised, controlled trial from the Boston Children's Hospital revealed a poor psychomotor developmental index after a year in young patients with a range of congenital cardiac conditions with haematocrits below 21.5% on CPB. 17 By contrast, no neurodevelopmental impairment was observed with a haematocrit below 20% in older patients 13 and infants 18 presenting for low-risk cardiac conditions.…”

“…13,[17][18][19] A randomised, controlled trial from the Boston Children's Hospital revealed a poor psychomotor developmental index after a year in young patients with a range of congenital cardiac conditions with haematocrits below 21.5% on CPB. 17 By contrast, no neurodevelopmental impairment was observed with a haematocrit below 20% in older patients 13 and infants 18 presenting for low-risk cardiac conditions. There were no outcome differences reported between liberal (9.5 g/dl) and restrictive (7 g/dl) haemoglobin strategies during the postoperative period in paediatric patients post acyanotic cardiac surgery in one study.…”