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

Abstract

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.

Keywords

cardiopulmonary bypass congenital heart defects blood transfusion-autologous blood preservation oxygenators-membrane

Get full access to this article

View all access options for this article.

References

Elliott MJ Recent advances in paediatric cardiopulmonary bypass. Perfusion 1999; 14: 237-246.

Jones TJ , Elliott MJ Paediatric CPB: bypass in a high risk group. Perfusion 2006; 21: 229-233. Review

Yeh T. , Minoo N. , Kavarana B. Cardiopulmonary bypass and the coagulation system. Prog Pediatr Cardiol 2005; 21: 87-115.

Thuys C. , Horton S. , Bennett M. , Augustin S.

New technology increases perioperative haemoglobin levels for paediatric cardiopulmonary bypass: what is the benefit?

Perfusion 2006 ; 21: 39-44.

Deptula J. , Glogowski K. , Merrigan K. , et al. Evaluation of biocompatible cardiopulmonary bypass circuit use during pediatric open heart surgery. JECT 2006; 38: 22-26.

Escobar GA , Cheng AM , Moore EE , et al. Stored packed red blood cell transfusion upregulates inflammatory gene expression in circulating leukocytes. Ann Surg 2007; 246: 129-134.

Repo H. , Jansson SE , Leirisalo-Repo M. Flow cytometric determination of CD11b upregulation in vivo. J Immunol Methods 1993; 164: 193-202.

Gunaydin S. , Farsak B. , Kocakulak M. , Sari T. , Yorgancioglu C. , Zorlutuna Y. Clinical performance and biocompatibility of poly (2-methoxyethylacrylate) coated extracorporeal circuits. Ann Thorac Surg 2002; 74(3): 819-824.

Gunaydin S. , McCusker K. , Vijay V. , et al. Comparison of polymethoxyethylacrylate-coated circuits with leukocyte filtration and reduced heparinization protocol on heparin-bonded circuits in different risk cohorts. Perfusion 2006; 21(6): 329-342.

10.

Larmann J. , Theilmeier G. Inflammatory response to cardiac surgery: cardiopulmonary bypass versus non-cardiopulmonary bypass surgery. Best Pract Res Clin Anaesthesiol 2004, 18(3): 425-438.

11.

Valleley MS , Buckley KW , Hayes KM , Fortuna RR , Geiss DM , Holt DW Are there benefits to a fresh whole blood vs. packed red blood cell cardiopulmonary bypass prime on outcomes in neonatal and pediatric cardiac surgery? JECT 2007; 39: 168-176.

12.

Charette K. , Hirata Y. , Bograd A. , et al. 180 ml and less: cardiopulmonary bypass techniques to minimize hemodilution for neonates and small infants. Perfusion 2007; 22; 327-31.

13.

Koster A. , Huebler M. , Boettcher W. , Redlin M. , Berger F. , Hetzer R. A new miniaturized cardiopulmonary bypass system reduces transfusion requirements during neonatal cardiac surgery: initial experience in 13 consecutive patients . J Thorac Cardiovasc Surg 2009; 137(6):1565-1568.

14.

Ging AL , Onge JR , Fitzgerald DC , Collazo LR , Bower LS , Shen I. Bloodless cardiac surgery and the pediatric patient: a case study. Perfusion 2008; 23; 131-134.

15.

Gunaydin S. , Sari T. , McCusker K. , Schonrock U. , Zorlutuna Y. Clinical evaluation of minimized extracorporeal circulation in high-risk coronary revascularization: impact on air handling, inflammation, hemodilution and myocardial function. Perfusion 2009; 24(3): 153-162.

16.

Scott BH , Seifert FC , Grimson R. Blood transfusion is associated with increased resource utilization, morbidity and mortality in cardiac surgery. Ann Card Anaesth 2008; 11: 15-19.