Open heart surgery for small children without homologous blood transfusion by using remote pump head system.
BACKGROUND
To avoid excessive hemodilution, the transfusion of a large amount of homologous blood may be required in open heart surgery for small children, which in turn, can cause a significant immunologic response.


METHODS
Cardiopulmonary bypass systems with remote pump heads were used for patients weighing 5 kg or less that were undergoing ventricular septal defect repair. The procedures took place from January 1997 to August 2002. The surgery was started with bloodless prime in 122 out of 158 (77.2%) consecutive patients. Exclusion criteria were a predicted hematocrit after the initiation of bypass of less than 15%, respiratory failure or heart failure (or both), and pulmonary vascular obstructive disease.


RESULTS
The mean age and body weight were 3.8 +/- 1.8 months and 4.3 +/- 0.5 kg, respectively. The priming volume was 181.0 +/- 32.5 (minimum: 130) mL. The hematocrit after cardiopulmonary bypass was initiated was 16.7% +/- 2.3%. Six patients required subsequent blood transfusion owing to postoperative complications that resulted in compromised hematopoiesis. In the rest, the hematocrit before discharge was 30.6% +/- 3.0%. Renal and liver function tests were maintained within the normal range. Patients were extubated at 5.6 +/- 2.8 hours after operation with proper oxygenation. Neurodevelopment was apparently normal. The Japanese psychomotor developmental scale assessment was given to patients without chromosomal abnormality between the ages of 1 and 3 years; the resulting score was 102.2 +/- 15.4 (mean = 100 for normal population).


CONCLUSIONS
Open heart surgery was achieved without blood transfusion in the selected group of small children. The use of remote pump heads reduced the overall need for blood transfusions and possibly inflammatory reactions.
Ando
Makoto
M
Department of Pediatric Cardiac Surgery, Sakakibara Heart Institute, Fuchu-si, Tokyo, Japan.
Takahashi
Yukihiro
Y
Suzuki
Natsuko
N
D000015:Abnormalities, Multiple / Q000601:surgery; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001831:Body Temperature; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D000077324:Crystalloid Solutions; D004298:Dopamine / Q000627:therapeutic use; D004867:Equipment Design; D004920:Erythropoiesis; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006400:Hematocrit; D006801:Humans; D007223:Infant; D007552:Isotonic Solutions; D007564:Japan; D008297:Male; D008904:Miniaturization; D010952:Plasma Substitutes / Q000008:administration & dosage; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D004298:Dopamine