title: Feasibility of blood conservation strategies in pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.
abstract: Blood transfusion requirements were reviewed for a consecutive series of 25 patients undergoing elective pulmonary endarterectomy (PEA) between August 2005 and March 2009 in our institution. Patients were divided into two groups based on the implementation of a conservative blood transfusion algorithm that combined antifibrinolytic therapy, intraoperative blood sequestration, blood salvage and lack of correction of coagulation parameters in the absence of ongoing bleeding. Despite similar perioperative coagulation profiles in the two groups, the introduction of a conservative blood transfusion algorithm was associated with a significant increase in the number of patients receiving no homologous blood products. Of 16 patients who underwent surgery after the introduction of the algorithm, nine (56%) required no homologous blood products and five (31%) required one or two units of homologous red blood cells only. The international normalized ratio normalized within six to 12 hours after discontinuation of cardiopulmonary bypass without transfusion of fresh frozen plasma or platelets in 13 of the 16 patients. In conclusion, a conservative blood transfusion strategy allows PEA to be safely performed with no or minimal blood product transfusions in a majority of patients despite deep hypothermic circulatory arrest.
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, University of Toronto, Toronto, ONT, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: McRae
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shargall
authors.forename: Martin
authors.initials: M
authors.lastname: Ma
authors.forename: John
authors.initials: J
authors.lastname: Thenganatt
authors.forename: Peter
authors.initials: P
authors.lastname: Slinger
authors.forename: John T
authors.initials: JT
authors.lastname: Granton
authors.forename: Marc
authors.initials: M
authors.lastname: de Perrot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001777:Blood Coagulation; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D002908:Chronic Disease; D050792:Circulatory Arrest, Deep Hypothermia Induced; D017558:Elective Surgical Procedures; D004691:Endarterectomy / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D057725:Operative Blood Salvage; D011651:Pulmonary Artery / Q000601:surgery*; D011655:Pulmonary Embolism / Q000097:blood / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents