Cardiac Surgery Without Transfusion: A Reappraisal

  • Richard K. Spence

Abstract

In the 1970’s, it was not uncommon for patients undergoing open heart surgery to be typed and crossed for 20 or more units of blood. Much of this was used to prime the heart/lung machine; some was transfused directly to the patient. At that time, blood transfusion was regarded as an innocuous procedure with little risk other than an occasional transfusion reaction and the rare case of hepatitis. We have learned much about the dangers of transfusion in cardiac surgery since that time, spurred on by the appearance of AIDS in a number of former patients. The risk of transmitting not only AIDS but also other viruses such as cytomegalovirus and hepatitis has been joined by the potential of immunosuppressing our patients and increasing their susceptibility to infection through transfusion. The need to avoid these complications and to provide a greater margin of safety are compelling reasons to review and revise our transfusion practices. The paragraphs that follow address the progress we have made toward the goal of bloodless cardiac surgery and offer both recommendations for current practice and suggestions for the future.

Keywords

Hepatitis Aspirin Heparin Pancreatitis Thrombin 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    T.A. Lowery, J.A. Clark: Successful implementation of a maximum surgical blood ordering schedule. J MedAssos GA 78-3:155–8;1989.Google Scholar
  2. 2.
    R.K. Spence: The status of bloodless surgery. Transf Med Rev Vol 4:274–86;1991.CrossRefGoogle Scholar
  3. 3.
    D.M. Cosgrove, F.D. Loop, B.N. Lytle, et al: Determinants of blood utilization during myocardial revascularfzation. Ann Thorac Surg 40:380–84;1985.PubMedCrossRefGoogle Scholar
  4. 4.
    D.A. Ott, D.A. Cooley: Cardiovascular surgery in Jehovah’s Witnesses. JAMA 238(12):1256–8;1977.PubMedCrossRefGoogle Scholar
  5. 5.
    D.V. Owings, M.S. Kruskall, R.L. Thurer, et al: Autologous blood donations prior to elective cardiac surgery. JAMA 262:1963;1968.CrossRefGoogle Scholar
  6. 6.
    P.T.C.Y Toy, R.G. Strauss, L.G. Stehling, et al: Predeposited autologous blood for elective surgery: A national multicenter study. N Enol J Med 316(9):517–520;1987.CrossRefGoogle Scholar
  7. 7.
    L.T. Goodnough, M.F.M. Johnston, PTCY Toy, et al: The variability oftransfusion practice in coronary artery bypass surgery. JAMA 265(1):86–90;1991.PubMedCrossRefGoogle Scholar
  8. 8.
    L.T. Goodnough: Erythropoietin as a pharmacologic alternative to blood transfUSion in the surgical patient. Transf Med Rev 4:288–296;1990.CrossRefGoogle Scholar
  9. 9.
    J. Pindyck, J. Avorn, M. Kuriyan, et al: Blood donation by the elderly: Clinical and policy decisions. JAMA 257:1186–1188;1987.PubMedCrossRefGoogle Scholar
  10. 10.
    P.G. Robertle, G.P. Grvalee: Safe limits ofisovolemic hemodilution and recommendations for erythrocyte transfusion. Int Anesthestol Clin 28:197–204;1990.CrossRefGoogle Scholar
  11. 11.
    A.J. DelRossi, A.C. Cernaianu, R.A. Vertrees, et al: Platelet-rich plasma reduces postoperative blood loss after cardiopulmonary bypass. J Thorac Cardiovasc Surg 100:281–286;1990.PubMedGoogle Scholar
  12. 12.
    E.W. Salzman, M.J. Weinstein, R.M. Weintraub, et al: Treatment with desmopressin acetate to reduce blood loss after cardiac surgery: A double blind randomized trial. N Engl J Med 314:1402–1406;1986.PubMedCrossRefGoogle Scholar
  13. 13.
    L.S.C. Czer, T.M. Bateman, R.J. Gray, et al: Treatment of severe platelet dysfunction and hemorrhage after cardiopulmonary bypass: Reduction in blood product usage with desmopressin. J Am CoU Cardtol 9:1139–1147;1987.CrossRefGoogle Scholar
  14. 14.
    E. Rocha, R. Llorens, J.A. Paramo, et al: Does desmopressin acetate reduce blood loss after surgery in patients on cardiopulmonary bypass? Circulation 77:1319–1323;1988.PubMedCrossRefGoogle Scholar
  15. 15.
    T. Hackman, R.D. Gascoyne, S.C. Naiman, et al: A trial of desmopressin (1-desamino-8-D-arginine-vasopressin) to reduce blood loss in uncomplicated cardiac surgery. N EnglJ Med 321:1437–1443;1989.CrossRefGoogle Scholar
  16. 16.
    D. Royston, B.P. Bidstrup, K.M. Taylor, et al: Effect of aprotlnin on need for transfusion after repeat open heart surgery. Lancet 2:1289–1291;1987.PubMedCrossRefGoogle Scholar
  17. 17.
    B.P. Bidstrup, D. Royston, R.N. Sapsford, et al: Reduction in blood loss after cardiopulmonary bypass using high dose aprotinin (Trasylol): Studies in patients undergoing aortocoronary bypass surgery, reoperations and valve replacement for endocarditis. J Thorac Cardtovasc Surg 97:364–372;1989.Google Scholar
  18. 18.
    G. Fraedrich G.C. Weber, H. Engler, et al: Benefits and riSks of aprotinin in open heart surgery. J Cardtovasc Surg 31:44;1990.Google Scholar
  19. 19.
    W. Van Oeveren, N.J. Jansen, B.P. Bidstrup, et al: Effects of aprotinin on hemostatic mechanism during cardiopulmonary bypass. Ann Thorac Surg 44:640–645;1987.PubMedCrossRefGoogle Scholar
  20. 20.
    H.B. Kram, R.C. Nathan, F.J. Stafford, et al: Fibrin glue achieves hemostasis in patients with coagulation dIsorders. Arch Surg 124:385–387;1989.PubMedCrossRefGoogle Scholar
  21. 21.
    R.K. Spence, S. McCoy, J. Costabile, et al: Fluosol DA-20% in the treatment of severe anemIa: Randomized, controlled study of 46 patients. Crit Care Med 18:1227–1230;1990.PubMedCrossRefGoogle Scholar
  22. 22.
    R.K. Spence: Fluosol and the heart. Cardiac Chron 5(1):1–6;1991.Google Scholar
  23. 23.
    C. Acar, M.T. Partington, G.D. Buckberg: Studies of controlled reperfusion after ischemia. J Thorac Cardiovasc Surg 101:284–293;1991.PubMedGoogle Scholar
  24. 24.
    T.I. Pristoupil, M. Vrana, J. Havlickova, et al: HemoglobIn solutions in experimental cardioplegIa. Int J ArtijOrgans 12(10):668–672;1989.Google Scholar
  25. 25.
    U. Martlniwitz, D.A. Goor, B. Ramot, et al: Is transfusIon of fresh plasma after cardiac operations indicate? J Thorac Cardiovasc Surg 100:92–98;1990.Google Scholar
  26. 26.
    M.J. London, J.S. Ho, J.K. Treidman, et al: A randomized clinIcal trial of 10% pentastarch (low molecular weight hydroxyethyl starch) versus 5% albumIn for plasma volume expansIon after cardiac operations. J Thome Cardiovasc Surg 97:785–797;1989.Google Scholar
  27. 27.
    A. Adan, A Brutel de le Riviere, F. Haas, et al: Autotransfusion of drained mediastinal blood after cardiac surgery: A reappraisal. Thorac Cardiovasc Surgeon 36:10–;1989CrossRefGoogle Scholar
  28. 28.
    B.R. Smoller, M.S. Kruskall: Phlebotomy for diagnostic laboratory tests in adults: Pattern of use and effect on transfUSion reqUirements. N Engl J Med 314:1233–1235;1986.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1992

Authors and Affiliations

  • Richard K. Spence
    • 1
  1. 1.Department of SurgeryUniversity of Medicine and Dentistry of New Jersey Robert Wood Johnson School of Medicine Cooper Hospital/University Medical CenterCamdenUSA

Personalised recommendations