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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
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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 

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