title: Minimizing intraoperative hemodilution by use of a very low priming volume cardiopulmonary bypass in neonates with transposition of the great arteries.
abstract: OBJECTIVE
  Owing to the mismatch between cardiopulomary bypass priming volume and infants' blood volume, pediatric cardiac surgery is often associated with transfusion of homologous blood, which may increase the risk of perioperative complications. Here we report the impact of a very low volume (95-110 mL) cardiopulmonary bypass circuit during arterial switch operations in neonates with transposition of the great arteries on blood requirements, tissue oxygenation, and patient outcome.
  
  
  METHODS
  Twenty-three consecutively treated neonates aged 2 to 17 days were treated with the blood-sparing approach. Asanguineous priming was used in all cases and packed red blood cells were added when hemoglobin concentration decreased below 7 g/dL. Cerebral and lower body tissue oxygenation was monitored by near-infrared spectroscopy. Intraoperative and postoperative transfusion, duration of ventilation and intensive care unit stay, wound infection, and 30-day mortality were assessed for patient outcome.
  
  
  RESULTS
  Intraoperative blood transfusion was necessary in 6 of 23 neonates. An additional 11 neonates received postoperative blood transfusions on the intensive care unit, leaving 6 infants who received no blood at all. Preoperative hemoglobin concentration was the only predictor for intraoperative transfusion requirement (11.6 ± 0.9 and 13.3 ± 0.4 g/dL in infants with and without intraoperative transfusion, respectively). Despite marked differences in hemoglobin concentrations between infants with and without transfusion, regional tissue oxygenation increased in both groups during cardiopulmonary bypass and returned to baseline at the end of surgery. In-hospital patient outcome was similar in both groups.
  
  
  CONCLUSIONS
  Transfusion-free complex cardiac surgery can be achieved even in neonates without jeopardizing tissue oxygenation or patient safety.
authors.affiliation: Department of Anesthesiology, German Heart Institute, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Redlin
authors.forename: Michael
authors.initials: M
authors.lastname: Huebler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Boettcher
authors.forename: Marian
authors.initials: M
authors.lastname: Kukucka
authors.forename: Helge
authors.initials: H
authors.lastname: Schoenfeld
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Helmut
authors.initials: H
authors.lastname: Habazettl
mesh_terms: D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D001803:Blood Transfusion / Q000401:mortality; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005858:Germany; D006438:Hemodilution; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D016343:Monitoring, Intraoperative / Q000379:methods; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D019265:Spectroscopy, Near-Infrared; D013997:Time Factors; D065227:Transfusion Reaction; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D010100:Oxygen