title: Five-year experience with mini-volume priming in infants ≤5 kg: safety of significantly smaller transfusion volumes.
abstract: Reducing the cardiopulmonary bypass (CPB) priming volume in congenital cardiac surgery is important because it is associated with fewer transfusions. This retrospective study was designed to compare safety and transfusion volumes between the mini-volume priming (MP) and conventional priming (CP) methods. Between 2007 and 2012, congenital heart surgery using CPB was performed on 480 infants (≤5 kg): the MP method was used in 331 infants (MP group, 69.0%), and the CP method was used in 149 infants (CP group, 31.0%). In the MP group, narrow-caliber (3/16″) tubing was used, and the pump heads were vertically aligned to shorten the tubing lengths. The smallest possible oxygenators and hemofilters were used, and vacuum drainage was applied. Ultrafiltration was vigorously applied during CPB to avoid excessive hemodilution. The mean age and body weight of the patients were 48 ± 41 (0-306) days and 3.8 ± 0.8 (1.3-5.0) kg, respectively. The total priming and transfusion volumes during CPB were lower in the MP group than in the CP group (141 ± 24 mL vs. 292 ± 50 mL, P < 0.001, and 82 ± 40 mL vs. 162 ± 82 mL, P < 0.001, respectively). In the MP group, the smallest priming volume was 110 mL. However, there was no significant difference in the lowest hematocrit level during CPB between the two groups (22 ± 3% vs. 22 ± 3%, P = 0.724). The incidence of postoperative neurological complications was not significantly different between the MP and CP groups (1.8% vs. 2.7%, P = 0.509). After adjustment for the Risk Adjustment for Congenital Heart Surgery category, body surface area, and age, MP was not an independent risk factor of postoperative neurological complications or early mortality (P = 0.213 and P = 0.467, respectively). The MP method reduced the priming volume to approximately 140 mL without increasing the risk of morbidity or mortality in infants ≤5 kg. The total transfusion volume during CPB was reduced by 50% without compromising hematocrit levels. We recommend the use of mini-volume priming, which is a safe and effective method for reducing transfusion volumes.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea.
authors.forename: Hyoung Woo
authors.initials: HW
authors.lastname: Chang
authors.forename: Jinhae
authors.initials: J
authors.lastname: Nam
authors.forename: Jae-Hee
authors.initials: JH
authors.lastname: Cho
authors.forename: Jeong-Ryul
authors.initials: JR
authors.lastname: Lee
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Woong-Han
authors.initials: WH
authors.lastname: Kim
mesh_terms: D001803:Blood Transfusion / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods*; D004867:Equipment Design; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D012189:Retrospective Studies
keywords: Blood transfusion; Cardiopulmonary bypass; Congenital heart defects; Equipment safety; Pediatric; Priming volume