Transfusion-Free Complex Cardiac Surgery With Cardiopulmonary Bypass in a 3.55-Kg Jehovah’s Witness Neonate

Open cardiac surgery in the first hours of life using autologous umbilical cord blood☆

“…One of the most potentially limiting factors to neonatal bloodless heart surgery is the low perioperative hematocrit level. Some investigators [11,12] reported that low-hematocrit bypass was effective in avoiding the need for homologous transfusion. Kurth et al [13] also reported that the lowest safe hematocrit level was approximately 15%.…”

“…However, a blood transfusion can potentially cause a variety of complications, such as an immunologic reaction that causes organ dysfunction and transmissions of pathogens [1,2]. To eliminate these risks, numerous blood management strategies were proposed to avoid homologous blood transfusions in congenital cardiac surgery, including miniaturized bypass systems, modified ultrafiltration, retrograde autologous priming, cell salvage, and autologous blood donation [3,[10][11][12]. Bloodless CPB strategies in infants are proposed but they have limited application, particularly in neonates with weight less than 4 kg [3].…”

Transfusion-Free Arterial Switch Operation in a 1.7-kg Premature Neonate Using a New Miniature Cardiopulmonary Bypass System

“…In view of the very low weight of the patient, we decided to downsize the CPB system as much as possible for improved attenuation of intraoperative blood trauma and CPB‐related systemic inflammatory response. Therefore, the following modifications of our previously described neonate CPB system on the mast mounted pediatric console (Stoeckert, Munich, Germany) were made: 3 all tubings were 3/16 inch inner diameter, except those for cardiotomy suction and venting which were replaced by lines usually employed as infusion lines. We also incorporated the new low prime KIDS D100 Oxygenator (Sorin, Mirandola, Italy) in combination with a new arterial line filter (D130, Sorin).…”

“…However, particularly in pediatric cardiac surgery the objective of safe, transfusion‐free surgery is often limited by the extreme hemodilution caused by the relative large volume of a conventional cardiopulmonary bypass (CPB) system. In a concerted effort to avoid transfusions even in these small patients whenever possible, we have strictly downsized our CPB systems while, however, maintaining all necessary safety features 3,4 . As a result of this, we are now able to report on the performance of a transfusion‐free arterial switch operation in a 1700‐gram prematurely born neonate.…”

Klinische Aspekte der Therapie mit Erythrozyten

“…und exemplarisch die Untersuchung von Nelson u. Bowen [33] Inzwischen kennen wir Hunderte von Publikationen, teilweise mit stattlichen Zahlen, über die fremdblutfreie operative Maximaltherapie an Zeugen Jehovas: Eingriffe wie Herz-oder Lebertransplantation [10,23,24], große Operation bei anämischen Schwangeren [7] oder große bauchchirurgische Eingriffe wie Whipple-Operation [17,21,29]. Auch Kleinkinder mit weniger als 5 kgKG wurden am Herzen operiert oder lebertransplantiert, ohne Blut zu verwenden [5,12,14,22,25]. Teilweise hatten Patienten über Stunden oder Tage kaum messbare Hämoglo-binkonzentrationen [38] und haben dennoch mit maximaler Therapie, aber ohne Blut überlebt.…”