Skip to main content

Blood Conservation and Management in Cardiac Surgery

  • Chapter
  • First Online:
Essentials of Blood Product Management in Anesthesia Practice

Abstract

Cardiac surgical procedures requiring cardiopulmonary bypass necessitate systemic anticoagulation and exposure to the pro-inflammatory extracorporeal circuit. Surgical procedures already account for 50% of all allogeneic blood product administration. Cardiac surgical procedures are high-risk for bleeding and allogeneic transfusion. Transfusion rates in cardiac surgery vary widely, with rates of 40–90% of cardiac surgical patients will receive a transfusion; cardiac surgical procedures consist of 10–20% of total blood product administration in the United States [1–4].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wells AW, Mounter PJ, Chapman CE, Stainsby D, Wallis JP. Where does blood go? Prospective observational study of red cell transfusion in North England. BMJ. 2002;325(7368):803.

    Article  CAS  Google Scholar 

  2. Stover EP, Siegel LC, Parks R, Levin J, Body SC, Maddi R, et al. Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines: a 24-institution study. Institutions of the Multicenter Study of Perioperative Ischemia Research Group. Anesthesiology. 1998;88(2):327–33.

    Article  CAS  Google Scholar 

  3. Hajjar LA, Vincent JL, Galas FR, Nakamura RE, Silva CM, Santos MH, et al. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010;304(14):1559–67.

    Article  CAS  Google Scholar 

  4. Society of Thoracic Surgeons Blood Conservation Guideline Task F, Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, et al. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg. 2011;91(3):944–82.

    Article  Google Scholar 

  5. Koch CG, Li L, Duncan AI, Mihaljevic T, Cosgrove DM, Loop FD, et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med. 2006;34(6):1608–16.

    Article  Google Scholar 

  6. Koch CG, Li L, Duncan AI, Mihaljevic T, Loop FD, Starr NJ, et al. Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg. 2006;81(5):1650–7.

    Article  Google Scholar 

  7. Hogan M, Klein AA, Richards T. The impact of anaemia and intravenous iron replacement therapy on outcomes in cardiac surgery. Eur J Cardiothorac Surg. 2015;47(2):218–26.

    Article  Google Scholar 

  8. Harker LA, Malpass TW, Branson HE, Hessel EA 2nd, Slichter SJ. Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: acquired transient platelet dysfunction associated with selective alpha-granule release. Blood. 1980;56(5):824–34.

    CAS  PubMed  Google Scholar 

  9. Edmunds LH Jr. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 1998;66(5 Suppl):S12–6; discussion S25-8.

    Article  Google Scholar 

  10. Kaplan JA, Augoustides JGT, Manecke GR, Maus T, Reich DL. Kaplan’s cardiac anesthesia: for cardiac and noncardiac surgery 7th Edition. Elsevier 2017.

    Google Scholar 

  11. Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic S, the European Association of Cardiothoracic A, Boer C, Meesters MI, Milojevic M, Benedetto U, et al. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018;32(1):88–120.

    Article  Google Scholar 

  12. Lazar HL. The use of preoperative aspirin in cardiac surgery: the ruling on the field stands. J Card Surg. 2017;32(12):775–6.

    Article  Google Scholar 

  13. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2011;58(24):e123–210.

    Article  Google Scholar 

  14. Liu H, Li J, Chen M, Yang T, Ruan Z, Su J, et al. A meta-analysis of randomized and observational studies: aspirin protects from cardiac surgery-associated acute kidney injury. Heart Surg Forum. 2019;22(4):E301–E7.

    Article  Google Scholar 

  15. Mangano DT, Multicenter Study of Perioperative Ischemia Research G. Aspirin and mortality from coronary bypass surgery. N Engl J Med. 2002;347(17):1309–17.

    Article  CAS  Google Scholar 

  16. Terwindt LE, Karlas AA, Eberl S, Wijnberge M, Driessen AHG, Veelo DP, et al. Patient blood management in the cardiac surgical setting: an updated overview. Transfus Apher Sci. 2019;58(4):397–407.

    Article  CAS  Google Scholar 

  17. Hofmann B, Kaufmann C, Stiller M, Neitzel T, Wienke A, Silber RE, et al. Positive impact of retrograde autologous priming in adult patients undergoing cardiac surgery: a randomized clinical trial. J Cardiothorac Surg. 2018;13(1):50.

    Article  Google Scholar 

  18. Rosengart TK, DeBois W, O’Hara M, Helm R, Gomez M, Lang SJ, et al. Retrograde autologous priming for cardiopulmonary bypass: a safe and effective means of decreasing hemodilution and transfusion requirements. J Thorac Cardiovasc Surg. 1998;115(2):426–38; discussion 38–9.

    Article  CAS  Google Scholar 

  19. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med. 2012;366(16):1489–97.

    Article  CAS  Google Scholar 

  20. Diegeler A, Borgermann J, Kappert U, Breuer M, Boning A, Ursulescu A, et al. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med. 2013;368(13):1189–98.

    Article  CAS  Google Scholar 

  21. Hallowell P, Bland JH, Buckley MJ, Lowenstein E. Transfusion of fresh autologous blood in open-heart surgery. A method for reducing bank blood requirements. J Thorac Cardiovasc Surg. 1972;64(6):941–8.

    Article  CAS  Google Scholar 

  22. Lawson NW, Ochsner JL, Mills NL, Leonard GL. The use of hemodilution and fresh autologous blood in open-heart surgery. Anesth Analg. 1974;53(5):672–83.

    Article  CAS  Google Scholar 

  23. Jarnagin WR, Gonen M, Maithel SK, Fong Y, D’Angelica MI, Dematteo RP, et al. A prospective randomized trial of acute normovolemic hemodilution compared to standard intraoperative management in patients undergoing major hepatic resection. Ann Surg. 2008;248(3):360–9.

    Article  Google Scholar 

  24. Henderson RA, Mazzeffi MA, Strauss ER, Williams B, Wipfli C, Dawood M, et al. Impact of intraoperative high-volume autologous blood collection on allogeneic transfusion during and after cardiac surgery: a propensity score matched analysis. Transfusion. 2019;59(6):2023–9.

    PubMed  Google Scholar 

  25. Barile L, Fominskiy E, Di Tomasso N, Alpizar Castro LE, Landoni G, De Luca M, et al. Acute normovolemic hemodilution reduces allogeneic red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis of randomized trials. Anesth Analg. 2017;124(3):743–52.

    Article  Google Scholar 

  26. Licker M, Sierra J, Kalangos A, Panos A, Diaper J, Ellenberger C. Cardioprotective effects of acute normovolemic hemodilution in patients with severe aortic stenosis undergoing valve replacement. Transfusion. 2007;47(2):341–50.

    Article  CAS  Google Scholar 

  27. Harke H, Tanger D, Furst-Denzer S, Paoachrysanthou C, Bernhard A. Effect of a preoperative separation of platelets on the postoperative blood loss subsequent to extracorporeal circulation in open heart surgery (author’s transl). Anaesthesist. 1977;26(2):64–71.

    CAS  PubMed  Google Scholar 

  28. Zhou SF, Estrera AL, Loubser P, Ignacio C, Panthayi S, Miller C 3rd, et al. Autologous platelet-rich plasma reduces transfusions during ascending aortic arch repair: a prospective, randomized, controlled trial. Ann Thorac Surg. 2015;99(4):1282–90.

    Article  Google Scholar 

  29. Bai SJ, Zeng B, Zhang L, Huang Z. Autologous platelet-rich plasmapheresis in cardiovascular surgery: a narrative review. J Cardiothorac Vasc Anesth. 2020;34(6):1614–21.

    Article  Google Scholar 

  30. von Heymann C, Sander M, Foer A, Heinemann A, Spiess B, Braun J, et al. The impact of an hematocrit of 20% during normothermic cardiopulmonary bypass for elective low risk coronary artery bypass graft surgery on oxygen delivery and clinical outcome--a randomized controlled study [ISRCTN35655335]. Crit Care. 2006;10(2):R58.

    Article  Google Scholar 

  31. Görlinger K. Coagulation management during liver transplantation. Hamostaseologie. 2006;26(3 Suppl 1):S64–76.

    PubMed  Google Scholar 

  32. Görlinger K, Shore-Lesserson L, Dirkmann D, Hanke AA, Rahe-Meyer N, Tanaka KA. Management of hemorrhage in cardiothoracic surgery. J Cardiothorac Vasc Anesth. 2013;27(4 Suppl):S20–34.

    Article  Google Scholar 

  33. Karlsson M, Ternstrom L, Hyllner M, Baghaei F, Nilsson S, Jeppsson A. Plasma fibrinogen level, bleeding, and transfusion after on-pump coronary artery bypass grafting surgery: a prospective observational study. Transfusion. 2008;48(10):2152–8.

    Article  CAS  Google Scholar 

  34. Karkouti K, McCluskey SA, Syed S, Pazaratz C, Poonawala H, Crowther MA. The influence of perioperative coagulation status on postoperative blood loss in complex cardiac surgery: a prospective observational study. Anesth Analg. 2010;110(6):1533–40.

    Article  Google Scholar 

  35. Li JY, Gong J, Zhu F, Moodie J, Newitt A, Uruthiramoorthy L, et al. Fibrinogen concentrate in cardiovascular surgery: a meta-analysis of randomized controlled trials. Anesth Analg. 2018;127(3):612–21.

    Article  CAS  Google Scholar 

  36. Erdoes G, Koster A, Meesters MI, Ortmann E, Bolliger D, Baryshnikova E, et al. The role of fibrinogen and fibrinogen concentrate in cardiac surgery: an international consensus statement from the Haemostasis and Transfusion Scientific Subcommittee of the European Association of Cardiothoracic Anaesthesiology. Anaesthesia. 2019;74(12):1589–600.

    Article  CAS  Google Scholar 

  37. Callum J, Farkouh ME, Scales DC, Heddle NM, Crowther M, Rao V, et al. Effect of fibrinogen concentrate vs cryoprecipitate on blood component transfusion after cardiac surgery: the fibres randomized clinical trial. JAMA. 2019;322:1–11.

    Article  Google Scholar 

  38. Ranucci M, Pistuddi V, Baryshnikova E, Colella D, Bianchi P. Fibrinogen levels after cardiac surgical procedures: association with postoperative bleeding, trigger values, and target values. Ann Thorac Surg. 2016;102(1):78–85.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Patrick O. McConville .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Moore, B.A., McConville, P.O. (2021). Blood Conservation and Management in Cardiac Surgery. In: Scher, C.S., Kaye, A.D., Liu, H., Perelman, S., Leavitt, S. (eds) Essentials of Blood Product Management in Anesthesia Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-59295-0_33

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-59295-0_33

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-59294-3

  • Online ISBN: 978-3-030-59295-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics