Perfusionist strategies for blood conservation in pediatric cardiac surgery

Perfusionist strategies for blood conservation in pediatric cardiac surgery,10.4330/wjc.v2.i2.27,World Journal of Cardiology,Yves Durandy,Paul Vermeer

Perfusionist strategies for blood conservation in pediatric cardiac surgery  
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There is increasing concern about the safety of homolo- gous blood transfusion during cardiac surgery, and a re- strictive transfusion practice is associated with improved outcome. Transfusion-free pediatric cardiac surgery is unrealistic for the vast majority of procedures in neo- nates or small infants; however, considerable progress has been made by using techniques that decrease the need for homologous blood products or even allow bloodless surgery in older infants and children. These techniques involve a decrease in prime volume by downsizing the bypass circuit with the help of vacuum- assisted venous drainage, microplegia, autologous blood predonation with or without infusion of recombinant (erythropoietin), cell salvaging, ultrafiltration and retro - grade autologous priming. The three major techniques which are simple, safe, efficient, and cost-effective are: a prime volume as small as possible, cardioplegia with negligible hydric balance and circuit residual blood sal- vaged without any alteration. Furthermore, these three techniques can be used for all the patients, including emergencies and small babies. In every pediatric sur- gical unit, a strategy to decrease or avoid blood bank transfusion must be implemented. A strategy to mini- mize transfusion requirement requires a combined effort involving the entire surgical team with pre-, peri-, and postoperative planning and management.
Journal: World Journal of Cardiology , vol. 2, no. 2, 2010
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