Original article
Congenital heart surgery
Blood Conservation Operations in Pediatric Cardiac Patients: A Paradigm Shift of Blood Use

https://doi.org/10.1016/j.athoracsur.2012.09.029Get rights and content

Background

Red blood cell transfusion is associated with high morbidity in pediatric patients undergoing cardiac operations. The aim of this study was to evaluate the clinical effects and outcomes of blood conservation for our pediatric patients undergoing cardiac operations.

Methods

We retrospectively analyzed a collected database of 168 pediatric patients who underwent biventricular (BV) and univentricular (UV) cardiac operations from 2006 to 2010. Patients were grouped into no blood conservation (n = 86 [BV = 74, UV = 12]) and blood conservation (n = 82 [BV = 68, UV = 14]) cohorts. There were no statistical differences in age, sex, weight, and preoperative or postoperative hemoglobin levels in the BV groups.

Results

Even though the blood conservation group had longer cardiopulmonary bypass (CPB) (p < 0.0001) and cross-clamp times (p < 0.002) with lower hemoglobin levels (p < 0.0001), there was a decreased need for intraoperative (p < 0.0001) and postoperative blood transfusions (p < 0.018), lower inotropic scores (p < 0.0001), a decrease in ventilator days (p < 0.0009), and a shorter length of hospital stay (p < 0.0008). In the UV blood conservation group, there were no statistical differences in age, sex, weight, CPB and cross-clamp times, preoperative and postoperative hemoglobin levels, and red blood cell transfusions despite lower intraoperative hemoglobin levels (p < 0.0009) and blood transfusion (p < 0.01) requirements. There were significantly lower inotropic scores (p < 0.001) and a trend toward a shorter duration of time on the ventilator (p < 0.07) in the blood conservation group. Logistic regression analysis demonstrated a significant correlation between intraoperative blood transfusion and increased inotropic score, longer duration on the ventilator, and increased length of hospitalization.

Conclusions

Blood conservation in pediatric cardiac operations is associated with fewer ventilator days, lower inotropic scores, and shorter lengths of stay. These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations.

Section snippets

Study Design

Retrospective analysis of 168 pediatric patients who underwent open cardiac operations from 2006 to 2010 was performed to compare the outcomes of blood conservation operations with traditional operations. The first group underwent surgical repair between 2006 and 2008 (historical control) by a different surgeon using conventional CPB without the availability and use of our current blood conservation equipment, techniques, and RBC transfusion protocol. The second group underwent surgical repair

Results

There were statistically no discernible differences in age, sex, weight, and preoperative and postoperative hemoglobin levels between the 2 groups for BV repair (Table 3). The blood conservation group had longer CPB (p < 0.0001) and cross-clamp times (p < 0.002), with lower hemoglobin levels (p < 0.0001) during the surgical procedure. There was less need for intraoperative (p < 0.0001) and postoperative RBC transfusions (p < 0.018), and there were lower inotropic scores (p < 0.0001), shorter

Comment

Blood conservation has been an ongoing quest since pediatric cardiac surgery was in its very infancy. Recent decades have witnessed many improvements in all stages of cardiac operations, allowing for a move toward bloodless surgical procedures in adult patients [6] and even in pediatric patients in some specific fields [7]. Moreover, blood transfusion has been associated with an increased mortality rate [8], and it remains unclear if it improves survival. Low hemoglobin levels during CPB in

Cited by (34)

  • Pediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You

    2019, Journal of Cardiothoracic and Vascular Anesthesia
    Citation Excerpt :

    However, it is important to note that a separate randomized trial demonstrated that a nadir hematocrit of 20% on CPB resulted in a lower postoperative cardiac index, higher lactate levels, and worsened neurodevelopmental outcomes at 1 year compared with nadir hematocrit of 30%.27 Follow-up studies suggest that a hematocrit of 24% is adequate to preserve both clinical and neurodevelopmental outcomes.26,28-30 However, neonates, patients with cyanotic disease, and other unique populations may require a higher hematocrit.

  • Blood utilization and conservation

    2018, Critical Heart Disease in Infants and Children
  • Blood Conservation

    2015, Seminars in Thoracic and Cardiovascular Surgery
    Citation Excerpt :

    95(3):962-7, 2013. Karimi et al8from Georgia Health Science University studied the implementation of a blood conservation strategy in pediatric cardiac patients. In 2008, a restructuring introduced a comprehensive blood conservation program.

  • Blood Transfusions After Pediatric Cardiac Operations: A North American Multicenter Prospective Study

    2015, Annals of Thoracic Surgery
    Citation Excerpt :

    These results must be interpreted with caution, however, because no definitive conclusion on a cause-and-effect relationship between RBC transfusion and poor outcomes of cardiac children who have received a transfusion can be drawn from a descriptive study [26]. In recent years, as a result of the accumulation of data suggesting an association between RBC transfusion and increased postoperative morbidity, a greater emphasis has been placed on blood conservation during pediatric cardiac operations [27]. Several strategies have been successfully used to reduce the need for postoperative RBC transfusion.

View all citing articles on Scopus
View full text