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Effects of cardiopulmonary bypass circuit reduction and residual volume salvage on allogeneic transfusion requirements in infants undergoing cardiac surgery

Department of Cardiothoracic Surgery and Department of Anaesthesiology, Bd 467, Erasmus MC, University Medical Center Rotterdam, dr.Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

*Corresponding author. Tel.: +31 10 4635208.

E-mail address: h.golab-schwarz{at}erasmusmc.nl (H.D. Golab).

Cardiopulmonary bypass in children may cause severe hemodilution and can lead to excessive perioperative blood loss and high transfusion requirements. Minimization of cardiopulmonary bypass circuit and salvage of red blood cells from the residual volume after the procedure are widely utilized to reduce allogeneic transfusion. We evaluated the effectiveness of those measures introduced in infant cardiac surgery in our institution. This retrospective observational study included 148 consecutive infants between 1 and 12 months of age, with a body weight <10 kg, who underwent an elective cardiac operation between 1997 and 2005. Patients were divided into three groups defined by the circuit prime volume; 700 ml (Group 1), 450 ml (Group 2) and 330 ml (Group 3). In Group 1 residual volume after perfusion was discarded and in Groups 2 and 3 was processed in a cell saving device. Analyzed variables were: perioperative blood loss, transfusion of homologous blood products and cell salvage product, and hematology data. Reduction of the circuit volume significantly diminished use of red blood cell concentrates from 1.6 units to 0.8 units (P<0.0001), and fresh frozen plasma from 1.3 units to 0.4 units (P<0.0001). Utilization of the cell salvage product reduced significantly (P=0.023) the postoperative need for homologous blood transfusion. Therefore, both measures proved to be effective in reducing homologous blood transfusion in infant cardiac surgery.

Key Words: Cardiopulmonary bypass; Infant; Blood conservation; Cell salvage; Blood transfusion

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ICVTS on-line discussion A Minimizing CPB circuit and reducing use of homologous blood products

Leo A. Bockeria, A. Kim, T. Averina, and A. Zaharchenko
Interactive CardioVascular and Thoracic Surgery 2007 6: 339. [Full Text] [PDF]

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				A. Koster, M. Huebler, W. Boettcher, M. Redlin, F. Berger, and R. Hetzer A new miniaturized cardiopulmonary bypass system reduces transfusion requirements during neonatal cardiac surgery: Initial experience in 13 consecutive patients. J. Thorac. Cardiovasc. Surg., June 1, 2009; 137(6): 1565 - 1568. [Full Text] [PDF]

				H. D. Golab, T. V. Scohy, P. L. de Jong, J. J.M. Takkenberg, and A. J.J.C. Bogers Intraoperative cell salvage in infants undergoing elective cardiac surgery: a prospective trial. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 354 - 359. [Abstract] [Full Text] [PDF]

				L. A. Bockeria, A. Kim, T. Averina, and A. Zaharchenko ICVTS on-line discussion A Minimizing CPB circuit and reducing use of homologous blood products Interactive CardioVascular and Thoracic Surgery, June 1, 2007; 6(3): 339 - 339. [Full Text] [PDF]