Department of Anesthesiology, German Heart Institute, Berlin, Germany.
J Thorac Cardiovasc Surg. 2012 Aug;144(2):493-9. doi: 10.1016/j.jtcvs.2012.01.008. Epub 2012 Feb 2.
Transfusion-free pediatric cardiac surgery remains a challenge, mainly owing to the mismatch between the cardiopulmonary bypass (CPB) priming volume and the infants' blood volume. Within a comprehensive blood-sparing approach, we developed body weight-adjusted miniaturized CPB circuits with priming volumes of 95, 110, and 200 mL for, respectively, infants weighing less than 3 kg, 3 to 5 kg and 5 to 16 kg. We analyzed the effects of this approach on transfusion requirements and risk factors predisposing for blood transfusion.
A total of 288 children with body weights between 1.7 and 15.9 kg were included and divided into 3 groups: No transfusion, postoperative transfusion only, and intraoperative and postoperative transfusion. Groups were compared by analysis of variance or analysis of variance on ranks. Risk factors predisposing for transfusion were identified by multivariate logistic regression.
Of the infants, 24.7% required no transfusion, 23.6% received postoperative transfusion only and 51.7% received intraoperative and postoperative transfusion. Groups differed by age, body weight, and size and by duration of surgery, CPB, and aortic crossclamp (P<.00001). Body weight (P<.00001), CPB duration (P<.00001), and persisting cyanosis (P=.03) were predictors of intraoperative and postoperative transfusion, whereas body weight (P=.00095), reoperations (P=.0051), and cyanotic heart defects (P=.035) were associated with postoperative transfusion only.
Our blood-sparing approach allows for transfusion-free surgery in a substantial number of infants. The strongest predictors of transfusion requirement, body weight and complexity of surgery as reflected by CPB duration, are not amenable to further improvements. Better preservation of the coagulatory system might allow for reduction of postoperative transfusion requirements.
无输血儿科心脏手术仍然是一个挑战，主要是由于体外循环（CPB）预充量与婴儿血量不匹配。在全面的血液节约方法中，我们开发了体重调整的小型 CPB 回路，预充量分别为 95、110 和 200ml，分别适用于体重小于 3kg、3 至 5kg 和 5 至 16kg 的婴儿。我们分析了这种方法对输血需求和输血风险因素的影响。
共纳入 288 名体重 1.7 至 15.9kg 的儿童，分为 3 组：无输血组、术后输血组和术中及术后输血组。采用方差分析或秩和分析比较各组。通过多变量逻辑回归识别输血的风险因素。
24.7%的婴儿无需输血，23.6%仅接受术后输血，51.7%接受术中及术后输血。组间差异与年龄、体重、体型以及手术时间、CPB 和主动脉阻断时间有关（P<.00001）。体重（P<.00001）、CPB 时间（P<.00001）和持续性发绀（P=.03）是术中及术后输血的预测因素，而体重（P=.00095）、再次手术（P=.0051）和紫绀性心脏缺陷（P=.035）与仅术后输血相关。
我们的血液节约方法允许大量婴儿进行无输血手术。输血需求的最强预测因素，即体重和手术的复杂性，反映在 CPB 时间上，无法进一步改善。更好地保护凝血系统可能会减少术后输血的需求。
