CARDIOPULMONARY BYPASS RE-INSTITUTION AND INTRAOPERATIVE REVISIONS ARE ASSOCIATED WITH INCREASED PERIOPERATIVE RISK IN CONGENITAL CARDIAC SURGERY

Introduction: Bloodless cardiac surgery defined as blood transfusion-free open-heart surgery, where cardiopulmonary bypass (CPB) circuits primed with crystalloid only and no intraoperative blood transfusion. Limited data have been published in this field. Hypothesis: We asked whether blood conservative surgery is feasible in congenital heart disease. Methods: We retrospectively reviewed patients who underwent bloodless cardiac surgery for congenital heart disease on CPB between January 2016 and December 2018. Our unique CPB system utilizes assisted venous drainage, bioactive coating, and reduced tubing size to decrease priming volume, and complement activation. Results: A total of 164 patients were reviewed (86 male and 78 female) at a median age of 9.6 years (range, 13 months-55 years), weight of 32 kg (IQR, 16-55), preoperative hemoglobin 13.7 g/dl (IQR, 12.6-14.9), and preoperative hematocrit of 40.3% (IQR, 37.2-44.3). Median CPB time was 81.5 minutes (IQR, 58-125), and median hematocrit coming off CPB was 26% (IQR, 23-29.7). Congenital Heart Surgery risk (STAT) category distributed in STAT 1 for 70 (43%), STAT 2 for 80 (49%), STAT 3 for 9 (5%), and STAT 4 for 5 (3%) of the patients. The majority (95%) of patients were extubated in the operating room with low complications rate during the hospital stay (7%). Only 6 (4%) patients needed a blood transfusion in the postoperative period with higher incidence of complications during the hospital course (LR 14.9; p<0.001). The median length of hospital stay was 3.6 days (IQR 2.6-5.6). There was no in-hospital mortality or 30 days mortality after surgery. Conclusions: Bloodless congenital cardiac surgery has a high success rate in selected low to medium surgical risk and even higher risk patients (STAT 3 and 4). Our patients had a low rate of complications and short hospital course. The blood product transfusion correlated significantly with a higher rate of complications during the postoperative course.

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Perioperative risk factors for serious gastrointestinal complications treated by laparotomy after cardiac surgery using cardiopulmonary bypass

Critical Care ◽

10.1186/cc9426 ◽

2011 ◽

Vol 15 (S1) ◽

Author(s):

P Soos ◽

B Schmack ◽

A Weymann ◽

G Veres ◽

B Merkely ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Perioperative Risk ◽

Gastrointestinal Complications ◽

Perioperative Risk Factors

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Risk Factors Associated with Cognitive Decline after Cardiac Surgery: A Systematic Review

Cardiovascular Psychiatry and Neurology ◽

10.1155/2015/370612 ◽

2015 ◽

Vol 2015 ◽

pp. 1-12 ◽

Cited By ~ 41

Author(s):

Nikil Patel ◽

Jatinder S. Minhas ◽

Emma M. L. Chung

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Cognitive Decline ◽

New Technologies ◽

Perioperative Risk ◽

Factors Associated ◽

Perioperative Risk Factors ◽

Postoperative Cognitive Decline

Modern day cardiac surgery evolved upon the advent of cardiopulmonary bypass machines (CPB) in the 1950s. Following this development, cardiac surgery in recent years has improved significantly. Despite such advances and the introduction of new technologies, neurological sequelae after cardiac surgery still exist. Ischaemic stroke, delirium, and cognitive impairment cause significant morbidity and mortality and unfortunately remain common complications. Postoperative cognitive decline (POCD) is believed to be associated with the presence of new ischaemic lesions originating from emboli entering the cerebral circulation during surgery. Cardiopulmonary bypass was thought to be the reason of POCD, but randomised controlled trials comparing with off-pump surgery show contradictory results. Attention has now turned to the growing evidence that perioperative risk factors, as well as patient-related risk factors, play an important role in early and late POCD. Clearly, identifying the mechanism of POCD is challenging. The purpose of this systematic review is to discuss the literature that has investigated patient and perioperative risk factors to better understand the magnitude of the risk factors associated with POCD after cardiac surgery.

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