Perfusionist strategies for blood conservation in pediatric cardiac surgery

Abstract

There is increasing concern about the safety of homologous blood transfusion during cardiac surgery, and a restrictive transfusion practice is associated with improved outcome. Transfusion-free pediatric cardiac surgery is unrealistic for the vast majority of procedures in neonates or small infants; however, considerable progress has been made by using techniques that decrease the need for homologous blood products or even allow bloodless surgery in older infants and children. These techniques involve a decrease in prime volume by downsizing the bypass circuit with the help of vacuumassisted venous drainage, microplegia, autologous blood predonation with or without infusion of recombinant (erythropoietin), cell salvaging, ultrafiltration and retrograde autologous priming. The three major techniques which are simple, safe, efficient, and cost-effective are: a prime volume as small as possible, cardioplegia with negligible hydric balance and circuit residual blood salvaged without any alteration. Furthermore, these three techniques can be used for all the patients, including emergencies and small babies. In every pediatric surgical unit, a strategy to decrease or avoid blood bank transfusion must be implemented. A strategy to minimize transfusion requirement requires a combined effort involving the entire surgical team with pre-, peri-, and postoperative planning and management.

Bloodless priming of the cardiopulmonary bypass circuit: determinants of successful transfusion-free operation in neonates and infants with a maximum body weight of 7 kg

“…The surgical team has to collaborate to achieve transfusion-free open-heart surgery in neonates and infants. Indeed, as emphasised by Durandy, 20 blood conservation is a perfect example of team work; everyone must be motivated to optimise reduction in blood use in the paediatric population.…”

Custodiol Solution and Cold Blood Cardioplegia in Arterial Switch Operation: Retrospective Analysis in a Single Center

“…In the blood group we used the microplegia that, in our center, is routinely used for the correction of congenital heart disease with shorter clamping times. [8][9][10]21,22 We performed mostly the Rashkind balloon atrial septostomy in blood group but this result is purely coincidental. Rashkind procedures were performed in 1 day of life for restrictive ASDs to improve the mixing of blood and to perform the correction at 1 week of age, but not for decompensate patients.…”

The successful introduction of an adapted form of the mini extra corporeal circulation used for cardiac surgery in an obese patient

“…A pressure transducer monitored the negative pressure in venous line. Retrograde Autologous Priming (RAP) was employed to limit haemodilution [ 5 ].…”