Thorac cardiovasc Surg
DOI: 10.1055/s-0038-1676789
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Asanguineous Cardiopulmonary Bypass in Infants: Impact on Postoperative Mortality and Morbidity

Peter Murin
1  Department of Congenital Heart Surgery - Pediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
,
Wolfgang Boettcher
1  Department of Congenital Heart Surgery - Pediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
,
Shinichi Ozaki
1  Department of Congenital Heart Surgery - Pediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
,
Alexa Wloch
1  Department of Congenital Heart Surgery - Pediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
,
Mi-Young Cho
1  Department of Congenital Heart Surgery - Pediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
,
Mathias Redlin
1  Department of Congenital Heart Surgery - Pediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
,
Oliver Miera
1  Department of Congenital Heart Surgery - Pediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
,
Nicodème Sinzobahamvya
1  Department of Congenital Heart Surgery - Pediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
,
Joachim Photiadis
1  Department of Congenital Heart Surgery - Pediatric Heart Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
› Author Affiliations
Funding None.
Further Information

Publication History

26 September 2018

12 November 2018

Publication Date:
02 January 2019 (online)

Abstract

Background We routinely start cardiopulmonary bypass (CPB) for pediatric congenital heart surgery without homologous blood, due to circuit miniaturization, and blood-saving measures. Blood transfusion is applied if hemoglobin concentration falls under 8 g/dL, or it is postponed to after coming off bypass or after operation. How this strategy impacts on postoperative mortality and morbidity, in infants weighing ≤ 7 kg?

Methods Six-hundred fifteen open-heart procedures performed from January 2014 to June 2018 were selected. One-hundred sixty-three patients (26.5%) were transfused on CPB (group 1), while 452 (73.5%) patients were not transfused on CPB (group 2). Operative risk and complexity were similar in both groups. Postoperative mortality and morbidity were compared. Multiple logistic regression was used to detect factors independently associated with outcome.

Results Observed mortality in nontransfused group (0.7% = 3/452) was significantly lower than expected (4.2% = 19/452): p = 0.0007, and much lower than in transfused group (6.7% = 11/163): p < 0.0001. CPB transfusion (p = 0.001) was independently associated with mortality, either acting as the sole factor or in combination with the Society of Thoracic Surgeons morbidity score (p = 0.013). Patients not transfused during CPB required less frequently vasoactive inotropic drugs (p = 0.011) and duration of their mechanical ventilation was shorter (93 ± 134 hours) than for transfused patients (142 ± 170 hours): p = 0.0003. CPB transfusion was an independent determinant factor for morbidity (p = 0.05), together with body weight (p < 0.0001), vasoactive inotropic score (p < 0.0001), CPB duration (p = 0.001), and postoperative transfusion (p = 0.009).

Conclusion The strategy of transfusion-free CPB course, feasible in most patients ≤ 7kg, was associated with improved outcome. Asanguineous priming of CPB circuit should become standard, even in neonates and infants.