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J. Thorac. Cardiovasc. Surg. · Mar 2024
Encouraging Results of Blood Conservation in Neonatal Open-Heart Surgery.
- Lyubomyr Bohuta, Kevin Charette, Titus Chan, Denise Joffe, Andrew Koth, Christina L Greene, David Mauchley, and D Michael McMullan.
- Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, Wash. Electronic address: Lyubomyr.Bohuta@seattlechildrens.org.
- J. Thorac. Cardiovasc. Surg. 2024 Mar 1; 167 (3): 115411631154-1163.
ObjectiveTo report early outcomes of blood conservation in neonatal open-heart surgery.MethodsNinety-nine patients undergoing neonatal open-heart surgery during the implementation of a blood conservation program between May 2021 and February 2023 were reviewed. Patients either received traditional blood management (blood prime, n = 43) or received blood conservation strategies (clear prime, n = 56). Baseline characteristics and outcomes were compared between groups.ResultsThere was no difference in body weight (median, 3.2 kg vs 3.3 kg; P = .83), age at surgery (median, 5 days vs 5 days; P = .37), distribution of The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories categories or duration of cardiopulmonary bypass. Patients in the clear prime group had higher preoperative hematocrit (median, 41% vs 38%; P < .01), shorter postoperative mechanical ventilation time (median, 48 hours vs 92 hours; P = .02) and postoperative intensive care unit length of stay (median, 6 days vs 9 days; P < .01) than patients in the blood prime group. Fourteen patients (25%) in the clear prime group, including 1 Norwood patient, were discharged without any transfusion. Among patients within the clear prime group, hospitalizations without blood exposure were associated with higher preoperative hematocrit (median, 43% vs 40%; P = .02), shorter postoperative mechanical ventilation times (median, 22 hours vs 66 hours; P = .01) and shorter postoperative hospital stays (median, 10 days vs 15 days; P = .02).ConclusionsBloodless surgery is possible in a significant proportion of neonates undergoing open-heart surgery, including the Norwood operation, even in the early stages of experience. Early clinical results are favorable but long-term follow-up and continued efforts are warranted to prove safety and reproducibility.Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
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