Open Cardiac Surgery without Blood and Blood Products Transplantation
Keywords:Cardiac surgery, blood products, transfusion, transplantation, bloodless surgery
Background: Blood transfusions are the most common type of tissue and organ transplantation. Perioperative and postoperative transfusions may cause morbidity and mortality and transfusion should based on only hematocrit values but also on hemodynamic and clinical parameters of the patient, which cannot be ignored.
Methods: A prospective study was conducted between January 2015 and October 2016 with adult patients undergoing elective open heart surgery. In these patients, a protocol was established, and patients were divided into two groups as transfusion (-) and transfusion (+). In the first 24 hours in the intensive care unit, patients’ drainage, 24-hours urine output, awakening and extubation times, and lactate and bilirubin levels in arterial blood gases were recorded. Thirty-day mortality and morbidity, and hemodynamic and clinical data were compared between these two groups.
Results: We have performed a total of 138 cases; no blood and blood products were transfused in 71% (n = 98), and in 29.0% (n = 40) blood and blood products were transfused. Thirty-day mortality and morbidity (arrhythmia, infectious and pulmonary morbidity, myocardial infarction, cerebrovascular accident, renal dysfunction, sternal revision) were compared between these two groups and no statistically significant difference was observed. Patients’ awakening, extubation time, cardiopulmonary bypass period, cross-clamp time, and days in intensive care unit and hospital were compared, and there was no statistically significant difference between the two groups.
Conclusion: In this study, we conclude that open heart surgery without blood transfusion may be accomplished with decent peri/postoperative management. The patients who did not receive any blood or blood products were not compromised clinically or hemodynamically. No extra morbidity and mortality were seen in the non-transfusion group. Transfusion decision was based on clinical and hemodynamic parameters such as persistent hypotension or tachycardia, hyperlactatemia, low urine output, and anemic symptoms.
Bennett-Guerrero E, Zhao Y, O’Brien SM, et al. 2010. Variation in use of blood transfusion in coronary artery bypass graft surgery. JAMA 304:1568-75.
Bernal JM, Naranjo S, Trugeda M, Sarralde A, Diago C, Revuelta JM. 2006. Cardiac Surgery in Jehovah’s Witnesses. Experience in Santander, Spain. Revista Española de Cardiología (English Edition) 59:507-9.
Bhaskar B, Jack RK, Mullany D, Fraser J. 2010. Comparison of outcome in Jehovah’s Witness patients in cardiac surgery: an Australian experience. Heart Lung Circ 19:655-9.
Ferraris VA, Ferraris SP, Saha SP, et al. 2007. Perioperative blood transfusion and blood conservation in cardiac surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline. Ann Thorac Surg 83:27-86.
Ferraris VA, Brown JR, Despotis GJ, et al. 2011. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 91:944-82.
Ferraris VA. 2015. Blood transfusion in cardiac surgery: who should get transfused? Lancet Haematol 2:510-11.
Kaplan M, Temur B, Can T, Abay G, Olsun A, Aydogan H. 2015. Open distal anastomosis technique for ascending aortic aneurysm repair without cerebral perfusion. Heart Surg Forum 18: E124-8.
Koch CG, Li L, Duncan AI, et al. 2006. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 34:1608-78.
Koch CG, Li L, Sessler DI, et al. 2008. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 358:1229-39.
Marshall L, Krampl C, Vrtik M, et al. 2012. Short-term outcomes after cardiac surgery in a Jehovah’s Witness population: an institutional experience. Heart Lung Circ 21:101-4.
McQuilten ZK, Andrianopoulos N, Wood EM, et al. 2014. Transfusion practice varies widely in cardiac surgery: Results from a national registry. J Thorac Cardiovasc Surg 147:1684-90.
Murphy GJ, Reeves BC, Rogers CA, Rizvi SI, Culliford L, Angelini GD. 2007. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 116:2544-52.
Murphy GJ, Pike K, Rogers CA, et al. 2015. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med 372:997-1008.
Patel NN, Avlonitis VS, Jones HE, Reeves BC, Sterne JA, Murphy GJ. 2015. Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis. Lancet Haematol 2: e543-53.
Pattakos G, Koch CG, Brizzio ME, et al. 2012. Outcome of patients who refuse transfusion after cardiac surgery: a natural experiment with severe blood conservation. Arch Intern Med 172:1154-60.
Pulido JN. 2015. Transfusion strategies in cardiac surgery: More pieces to the puzzle, more questions to be answered. J Thorac Cardiovasc Surg 150:1320-1.
Ranucci M, Baryshnikova E, Castelvecchio S, Pelissero G. 2013. Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. Ann Thorac Surg 96:478-85.
Senay S, Toraman F, Karabulut H, Alhan C. 2009. Is it the patient or the physician who cannot tolerate anemia? A prospective analysis in 1854 non-transfused coronary artery surgery patients. Perfusion 24:373-80.