Issue |
J Extra Corpor Technol
Volume 49, Number 2, June 2017
|
|
---|---|---|
Page(s) | 93 - 97 | |
DOI | https://doi.org/10.1051/ject/201749093 | |
Published online | 15 June 2017 |
Original Articles
Complex Cardiac Surgery on Patients with a Body Weight of Less Than 5 kg without Donor Blood Transfusion
* Departments of Congenital Heart Surgery and Pediatric Heart Surgery
† Anesthesiology
‡ Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Address correspondence to: Wolfgang Boettcher, ECCP, Deutsches Herzzentrum Berlin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail: boettcher@dhzb.de
Received:
4
December
2016
Accepted:
27
February
2017
Performing safe cardiac surgery in neonates or infants whose parents are Jehovah's Witnesses is only possible in a coordinated team approach. An unconditional prerequisite is a cardiopulmonary bypass (CPB) circuit with a very low priming volume to minimize hemodilution. In the past decade, we have developed a functional blood-sparing approach at our institution. The extracorporeal circuit was miniaturized. This had to be recently adapted, faced with a challenge associated with the switch to high-volume crystalloid cardioplegia. A filtration circuit was added. Here, we report an open heart surgery on three consecutive children of Jehovah's Witness parents with a body weight of 2.7, 4.5, and 4.8 kg, respectively. Procedures consisted of one arterial switch operation and two repairs of complete atrioventricular septal defects. Our static priming volume of less than 90 mL resulted in a nadir hematocrit during CPB of 27.7% (Hb 8.9 g/dL) in a patient which happened to have the lowest body weight of 2.7 kg. The two other patients had their lowest hematocrit at 31.4% (Hb 10.2 g/dL). The three children could be treated without any kind of transfusion of blood which had left the circulation or its extensions, in accordance with the parents' wishes, and enjoy favorable outcomes without transfusion of blood products during their entire hospital stay.
Key words: cardiopulmonary bypass / blood transfusion / Jehovah's Witnesses / newborn / infant / transfusion free / bloodless
© 2017 AMSECT
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