Bloodless Cardiac Surgery Program
Cardiac surgery procedures often require transfusions due to their complexity compared to other surgical procedures. Except for selected coronary bypass operation (CABG) and percutaneous aortic valve replacements (TAVR), most cardiac operation require the use of the “Heart-Lung machine” (CPB) to support the circulation while the heart is intervened. The use of cardiopulmonary bypass (CPB) results in hemodilution (anemia) and derangement of the coagulation system and affectation of the platelets and clotting factors, resulting in bleeding and the need to use blood products to reverse the problem. The average rate of transfusion for simpler operations such as CABG (coronary bypass) and simple valve operations is over 38 %-40 % (Society of Thoracic Surgeons database).
There is a group of patients that for religious beliefs or other non-clinical reasons will not accept blood or blood products and we are respectful of those religious reasons not to have blood, if so is chose. Other patients cannot receive blood products due to antibodies or agglutinin problems.
We have a universal approach to avoid transfusion in all patients and we have protocols to optimize the blood mass before, during and after surgery, resulting in improved blood conservation and very low transfusion rates (< 15% in CABG patients).
Our blood less approach starts with optimization of the red cell mass by using erythropoietin to increase the hematocrits over 35-40% and avoid volume overload (dilution) before and after surgery. During surgery we avoid hemodilution on the CPB machine by hemoconcentration techniques and heparin coated systems and the use of pressors medications instead of fluids. We use cell saver devices and tolerate low HgB levels. In patients with coronary artery disease we avoid the use of CPB all together and use “beating hearts” techniques. A very meticulous hemostatic “drying” technique is used in all patients.
These techniques are used universally in all of our open heart operations, and transfusions are given judiciously at very low HgB levels or when bleeding is present. Jehovah’s Witnesses and other no-blood patients are never transfused against their will.
We have a large experience with no-blood patients due to religious belief and all expectations, optimization options and surgical plans are delineated at the consultation time to the patients and families by our surgical team.