Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-22T05:57:38.904Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  23 July 2018

Alexa Wloch ,
Wolfgang Boettcher ,
Nicodème Sinzobahamvya ,
Mi-Young Cho ,
Mathias Redlin ,
Ingo Dähnert  and
Joachim Photiadis
Alexa Wloch
Affiliation:
Department of Congenital Heart Surgery – Paediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
Wolfgang Boettcher
Affiliation:
Department of Congenital Heart Surgery – Paediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
Nicodème Sinzobahamvya*
Affiliation:
Department of Congenital Heart Surgery – Paediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
Mi-Young Cho
Affiliation:
Department of Congenital Heart Surgery – Paediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
Mathias Redlin
Affiliation:
Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Ingo Dähnert
Affiliation:
Clinic for Paediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany
Joachim Photiadis
Affiliation:
Department of Congenital Heart Surgery – Paediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
*
Author for correspondence: N. Sinzobahamvya, MD, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49 30 45933401; Fax: +49 30 45933500; E-mail: n.sinzobahamvya@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

We currently perform open-heart procedures using bloodless priming of cardiopulmonary bypass circuits regardless of a patient’s body weight. This study presents results of this blood-saving approach in neonates and infants with a body weight of up to 7 kg. It tests with multivariate analysis factors that affect perioperative transfusion. A total of 498 open-heart procedures were carried out in the period 2014–2016 and were analysed. Priming volume ranged from 73 ml for patients weighing up to 2.5 kg to 110 ml for those weighing over 5 kg. Transfusion threshold during cardiopulmonary bypass was 8 g/dl of haemoglobin concentration. Transfusion factors were first analysed individually. Variables with a p-value lower than 0.2 underwent logistic regression. Extracorporeal circulation was conducted without transfusion of blood in 335 procedures – that is, 67% of cases. Transfusion-free operation was achieved in 136 patients (27%) and was more frequently observed after arterial switch operation and ventricular septal defect repair (12/18=66.7%). It was never observed after Norwood procedure (0/33=0%). Lower mortality score (p=0.001), anaesthesia provided by a certain physician (p=0.006), first chest entry (p=0.013), and higher haemoglobin concentration before going on bypass (p=0.013) supported transfusion-free operation. Early postoperative mortality was 4.4% (22/498). It was lower than expected (6.4%: 32/498). In conclusion, by adjusting the circuit, cardiopulmonary bypass could be conducted without donor blood in majority of patients, regardless of body weight. Transfusion-free open-heart surgery in neonates and infants requires team cooperation. It was more often achieved in procedures with lower mortality score.

Keywords

Cardiopulmonary bypasscongenital heart surgeryrestrictive blood transfusionneonates and infants
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 10 , October 2018 , pp. 1141 - 1147
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Cooper, JR, Giesecke, NM. Hemodilution and priming solutions. In Gravlee GP, Davis RF, Hammon JW, Kussman BD, (eds) Cardiopulmonary Bypass and Mechanical Support, 4th edn. Wolters Kluwer, Riverwoods, Illinois, 2015: 421–432.Google Scholar
2. Patel, NN, Avlonitis, V, Jones, HE, Reeves, BC, Sterne, JA, Murphy, GJ. Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis. Lancet Haematol 2015; 2: e543–553.Google Scholar
3. Boettcher, W, Sinzobahamvya, N, Miera, O, et al. Routine application of bloodless priming in neonatal cardiopulmonary bypass: a 3-year experience. Pediatr Cardiol 2017; 38: 807–812.Google Scholar
4. Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911–924.Google Scholar
5. O’Brien, SM, Clarke, DR, Jacobs, JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 2009; 138: 1139–1153.Google Scholar
6. Redlin, M, Boettcher, W, Dehmel, F, Cho, MY, Kukucka, M, Habazettl, H. Accuracy of predicted haemoglobin concentration on cardiopulmonary bypass in paediatric cardiac surgery: effect of different formulae for estimating patient blood. Perfusion 2017; 32: 639–644.Google Scholar
7. Gaies, MG, Jeffries, HE, Niebler, RA, et al. Vasoactive-inotropic score is associated with outcome after infant cardiac surgery: an analysis from the Pediatric Cardiac Critical Care Consortium and Virtual PICU System Registries. Pediatr Crit Care Med 2014; 15: 529–537.Google Scholar
8. Scherer, B, Moser, EA, Brown, JW, Rodefeld, MD, Turrentine, MW, Mastropietro, CW. Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease. J Thorac Cardiovasc Surg 2016; 152: 1423–1429.e1.Google Scholar
9. Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA, Ferraris SP, Saha SP, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline. Ann Thorac Surg 2007; 83 (Suppl): S27–86.Google Scholar
10. Ranucci, M, Carlucci, C, Isgro, G, et al. Duration of red blood cell storage and outcomes in pediatric cardiac surgery: an association found for pump prime blood. Crit Care 2009; 13: R207.Google Scholar
11. Redlin, M, Boettcher, W, Kukucka, M, Kuppe, H, Habazettl, H. Blood transfusion during versus after cardiopulmonary bypass is associated with postoperative morbidity in neonates undergoing cardiac surgery. Perfusion 2014; 29: 327–332.Google Scholar
12. Redlin, M, Habazettl, H, Boettcher, W, et al. Effects of a comprehensive blood-sparing approach using body weight-adjusted miniaturized cardiopulmonary bypass circuits on transfusion requirements in pediatric cardiac surgery. J Thorac Cardiovasc Surg 2012; 144: 493–499.Google Scholar
13. Székely, A, Cserép, Z, Sápi, E, et al. Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations. Ann Thorac Surg 2009; 87: 187–197.Google Scholar
14. Kotani, Y, Honjo, O, Nakakura, M, et al. Single center experience with a low volume priming cardiopulmonary bypass circuit for preventing blood transfusion in infants and small children. ASAIO J 2009; 55: 296–299.Google Scholar
15. Miyaji, K, Kohira, S, Miyamoto, T, et al. Pediatric cardiac surgery without homologous blood transfusion, using a miniaturized bypass system in infants with lower body weight. J Thorac Cardiovasc Surg 2007; 134: 284–289.Google Scholar
16. Lau, CL, Posther, KE, Stephenson, GR, et al. Mini-circuit cardiopulmonary bypass with vacuum assisted venous drainage: feasibility of an asanguineous prime in the neonate. Perfusion 1999; 14: 389–396.Google Scholar
17. Sinzobahamvya, N, Weber, T, Sata, S, et al. Quantification of morbidity associated with congenital heart surgery. Thorac Cardiovasc Surg 2013; 61: 278–285.Google Scholar
18. de Gast-Bakker, DH, de Wilde, RB, Hazekamp, MG, et al. Safety and effects of two red blood cell transfusion strategies in pediatric cardiac surgery patients: a randomized controlled trial. Intensive Care Med 2013; 39: 2011–2019.Google Scholar
19. Kwak, JG, Park, M, Lee, J, Lee, CH. Multiple approaches to minimize transfusions for pediatric patients in open-heart surgery. Pediatr Cardiol 2016; 37: 44–49.Google Scholar
20. Durandy, Y. Perfusionist strategies for blood conservation in pediatric cardiac surgery. World J Cardiol 2010; 2: 27–33.Google Scholar