Original Article

The Routine Performance of Open-Heart Surgery Without Blood

From the Department of Cardiac Surgery (Drs. Housman and Litchford) and Cardiology (Dr. Mazur), Mercy Hospital and Medical Center, San Diego, California 92103.

^* Address all correspondence to Leland B. Housman, M.D., 3563 Fourth Avenue, San Diego, California 92103.

Abstract

The dramatic geometric increases in open-heart procedures have aggravated demands on blood banks. Recent surveys indicate a continual national average of eight units/patient. This study was undertaken to demonstrate the feasibility and advantages of bloodless cardiac surgery. Two groups of 100 patients each, similar in age, sex, procedures performed and pre-operative hematocrit values are analyzed. Group I patients were transfused routinely; every effort was made to avoid blood in Group II. Intra-operative P_aO₂, pH and Hematocrit values were similar. Total measurable blood loss was less in Group II, reflecting more careful technique. Mean transfusion (units/patient) was 8.5 in Group I, and only 0.5 in Group II (75% received no blood, 95% 2 units or less). Oxygen requirements, acidosis, pulmonary complications and hepatitis (zero) were Jess in Group II. All Group II patients received oral FeS0₄ and two weeks post-discharge 92% had hematocrit values ≥ 30 vol% with 56% being ≥ 35 vol %. Cardiac surgery can be safely performed without transfusion, specific benefits are afforded, and consequently this technique is recommended.

The volume of cardiac surgery performed in the United States has increased in the last five years, chiefly due to the advent of coronary artery bypass surgery. ¹ This has placed an obligatory and sometimes unmeetable obligation on blood banks across the country, since the average amount of blood used per cardiopulmonary bypass procedure remains 8.5 units/patient nationally. ² Based on laboratory and clinical reports, ^3.4 there is ample evidence that cardiac surgery can be performed safely without the use of autologous banked blood. The elimination of transfusion, in addition to relieving the everincreasing demands on blood banks, also dramatically decreases the incidence of hepatitis, transfusion reaction and various coagulopathies. The techniques of hemodilution may well enhance tissue perfusion during bypass, ^3,5,6 and combined with autologous transfusion with the patient's own blood further decreases the necessity for blood transfusion. This study was undertaken to demonstrate not only the feasibility but the advantages of bloodless cardiac surgery.