Proceedings

Blood Conservation during Open Heart Surgery in Infants and Children

Divisions of Cardiovascular Surgery and Anesthesiology, Children’s Hospital of San Diego, Donald N. Sharp Memorial Hospital and the University of California School of Medicine, San Diego, CA

^* Direct communications to: John J. Lamberti, M.D., 7920 Frost St., Suite 304, San Diego, CA 92123

Abstract

We studied 211 consecutive patients (age 1/12 to 18 7/12 years, median 2 3/12 years; weight 2 to 70 kg., median 11.2 kg.) undergoing cardiopulmonary bypass (CPB) for repair of congenital heart defects from September 1978 to September 1982 to determine blood used at surgery and within 48 hours of operation. There were 10/211 (4.7%) peri-operative deaths and 21 patients bled more than 500 cc from chest tubes during the first twelve hours post-op; 4 ( 4/211 = 1.9%) required re-exploration. This left 180 uncomplicated cases. From 1978 to 1982: (1) The average number of units of packed red blood cells (PRC) used per patient decreased from 4.3 to 1.9 for the entire patient population and from 4.1 to 1.2 for uncomplicated cases; (2) the average number of PRC units used for CPB prime decreased from 1.9 to 0.5; and (3) average end-CPB hematocrit decreased from 27.9 to 22.6%. All differences are highly significant (p 0.001). Peri-operative and postoperative morbidity were unchanged over the course of the study. In 1982, 23/48 (48%) cases used nonblood prime (weight 8.8 to 70 kig., median 27.0 kg.; median pre-op Hct 45.0%) and 25/48 (52%) cases used 1 unit (weight 3.5 to 16.6 kg., median 9.0 kg.; median pre-op Hct 37.1 %). Through a conscious effort to conserve blood, we substantially reduced our banked blood requirements for congenital heart surgery. Blood conservation reduces cost, spares resources, and minimizes risk of transfusion reaction and infectious disease, but does not increase the morbidity of congenital heart surgery.