Complex Cardiac Surgery on Patients with a Body Weight of Less Than 5 kg without Donor Blood Transfusion.

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.

Novel ultrafiltration technique for blood conservation in cardiac operations.

PURPOSE: The performance characteristics and clinical outcome of a novel hemoconcentrator, the HemoSep (Brightwake, Nottingham, United Kingdom), for reusing salvaged blood postoperatively were evaluated. DESCRIPTION: HemoSep concentrates blood by removing the fluid component from a pooled volume of blood salvaged at the end of the operation from the heart-lung machine. During a 6-month period, 102 patients were prospectively randomized into two groups. In group 1 (n = 52), salvaged blood in the venous reservoir after the cessation of cardiopulmonary bypass was reused by the HemoSep device and the processed blood was retransfused to the patients. In group 2 (n = 50), the control group, the operation proceeded using conventional method without using the hemoconcentrator. EVALUATION: The mean amount of processed blood was 775 ± 125 mL. The efficacy of the HemoSep device was confirmed by the percentage concentration of the hematocrit at 15 and 40 minutes. Serum albumin and factor VII levels were concentrated more than threefold at 40 minutes vs baseline measurements. Patients who received processed blood had significantly less need for an allogeneic transfusion. CONCLUSIONS: The HemoSep device functions as designed and without technical failures, offering a complementary technique in blood management during cardiac operations.