Perioperative blood conservation strategies in pediatric patients undergoing open-heart surgery: impact of non-autologous blood transfusion and surface-coated extracorporeal circuits

Background: The aim of this study was to explore the relative clinical and biomaterial effects of blood transfusions (Tx) and novel low-prime, surface-coated circuitry on perioperative outcome in a pediatric population undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: Over a 12-month period, 80 patients weighing >10 kg undergoing ventricular septal defect (VSD) repair with CPB were prospectively randomized into two groups according to the type of CBP circuit used, then each randomized group was enrolled into two groups again, according to the need for transfusion (N=20): Group 1- Tx-free procedures on low-prime, surface-coated extracorporeal circuitry (FX05, Terumo); Group 2- procedures requiring Tx on coated circuitry; Group 3- Tx-free procedures with standard uncoated circuitry (D902, Sorin); Group 4 (Control)- procedures requiring Tx on uncoated circuitry. Blood samples were collected at baseline (T1), at the end of the CPB (T2) and 24 h (T3) postoperatively. rSO2 desaturation risk score >6000 (Invos, Somanetics) was calculated by multiplying rSO2 <50% by time. Results: IL-6 levels (pg/ml) were significantly lower in Groups 1 and 3 versus control at T2 (13±4; 17±5 versus 33±8; p<0.05). CD11b/CD18 levels (%) were significantly lower in Group 1 (12±4) versus control (25±8) at T2 (p<0.05). Respiratory support time (h) was significantly less in Group 1 (11.4±6) versus control (19.8±7) (p<0.05). rSO2 desaturation risk >6000 (%) was 15.7±9 in Group 1 and 26.8±11 in control (p<0.05). Conclusion: Allogenic Tx amplifies the CPB-related inflammatory response. It is feasible to do congenital procedures safely without Tx for patients weighing >10 kg by using combined blood management strategies.

[1]  R. Hetzer,et al.  A new miniaturized cardiopulmonary bypass system reduces transfusion requirements during neonatal cardiac surgery: initial experience in 13 consecutive patients. , 2009, The Journal of thoracic and cardiovascular surgery.

[2]  Y. Zorlutuna,et al.  Clinical evaluation of minimized extracorporeal circulation in high-risk coronary revascularization: impact on air handling, inflammation, hemodilution and myocardial function , 2009, Perfusion.

[3]  I. Shen,et al.  Bloodless cardiac surgery and the pediatric patient: a case study , 2008, Perfusion.

[4]  R. Grimson,et al.  Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. , 2008, Annals of cardiac anaesthesia.

[5]  A. Bograd,et al.  180 ml and less: Cardiopulmonary bypass techniques to minimize hemodilution for neonates and small infants , 2007, Perfusion.

[6]  D. Holt,et al.  Are there benefits to a fresh whole blood vs. packed red blood cell cardiopulmonary bypass prime on outcomes in neonatal and pediatric cardiac surgery? , 2007, The journal of extra-corporeal technology.

[7]  H. Baker,et al.  Stored Packed Red Blood Cell Transfusion Up-regulates Inflammatory Gene Expression in Circulating Leukocytes , 2007, Annals of surgery.

[8]  Y. Zorlutuna,et al.  Comparison of polymethoxyethylacrylate-coated circuits with leukocyte filtration and reduced heparinization protocol on heparin-bonded circuits in different risk cohorts , 2006, Perfusion.

[9]  M. Elliott,et al.  Paediatric CPB: Bypass in a High Risk Group , 2006, Perfusion.

[10]  J. Hammel,et al.  Evaluation of biocompatible cardiopulmonary bypass circuit use during pediatric open heart surgery. , 2006, The journal of extra-corporeal technology.

[11]  C. Thuys,et al.  New technology increases perioperative haemoglobin levels for paediatric cardiopulmonary bypass: what is the benefit? , 2006, Perfusion.

[12]  M. Kavarana,et al.  Cardiopulmonary bypass and the coagulation system , 2005 .

[13]  G. Theilmeier,et al.  Inflammatory response to cardiac surgery: cardiopulmonary bypass versus non-cardiopulmonary bypass surgery. , 2004, Best practice & research. Clinical anaesthesiology.

[14]  Y. Zorlutuna,et al.  Clinical performance and biocompatibility of poly(2-methoxyethylacrylate)-coated extracorporeal circuits. , 2002, The Annals of thoracic surgery.

[15]  A. Undar,et al.  Recent advances in paediatric cardiopulmonary bypass. , 2000, Perfusion.

[16]  H. Repo,et al.  Flow cytometric determination of CD11b upregulation in vivo. , 1993, Journal of immunological methods.