Bloodless Surgery and Its Application in Cardiac Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XING Wanhong , XU Zhiwei.

1. Department of Cardio-thoracic Surgery，Second Hospital of Shanxi Medical University，Taiyuan 030001，P. R. China;;
2. Department of Cardiothoracic Surgery，Shanghai Children’s Medical Center，School of Medicine，Shanghai JiaotongUniversity，Shanghai 200127，P. R. China;

Corresponding author：

Keywords：

Bloodless surgery; 　Cardiac surgery; 　Application

DOI：

10.7507/1007-4848.20130218

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Bloodless surgery is a comprehensive and systematic perioperative treatment approach in order to avoid allogeneic transfusion for surgery，improve patient prognosis，and relieve blood shortage. Bloodless heart surgery indicates some perioperative strategies to avoid allogeneic transfusion and improve clinical outcomes，which involves participation of cardiac surgeons and other professionals during cardiac surgery. For years，many cardiac surgeons have utilized several blood management and conservation techniques during open heart surgery to avoid allogeneic transfusion. Research results from major medical centers indicate that bloodless heart surgery can shorten postoperative recovery period and improve patientprognosis. In this review，we describe basic theory and systematic methods of bloodless surgery，and summarize applicationprogress of bloodless heart surgery and current status in China.

Citation： XING Wanhong,XU Zhiwei.. Bloodless Surgery and Its Application in Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(6): 719-722. doi: 10.7507/1007-4848.20130218 Copy

1.	Ott DA， Cooley DA. Cardiovascular surgery in Jehovah's Witnesses. Report of 542 operations without blood transfusion. JAMA， 1977， 238 （12）：1256-1258.
2.	Spahn DR， Casutt M. Eliminating blood transfusions：new aspects and perspectives. Anesthesiology， 2000， 93 （1）：42-55.
3.	Rosengart TK， Helm RE， DeBois WJ， et al. Open heart operations without transfusion using a multimodality blood conservation strategy in 50 Jehovah's Witness patients：implications for a “bloodless” surg-ical technique. J Am Coll Surg， 1997， 184 （6）：618-629.
4.	Helm RE， Rosengart TK， Gomez M， et al. Comprehensive multimo-dality blood conservation：100 consecutive CABG operations without transfusion. Ann Thorac Surg， 1998， 65 （1）：125-136.
5.	Goodnough LT， Skikne B， Brugnara C. Erythropoietin， iron， and erythropoiesis. Blood， 2000， 96 （3）：823-833.
6.	Salem MR， Manley S. Blood conservation techniques. In：Ramez Salem M， editor. Blood conservation in the surgical patient. London：Williams and Wilkins， 1996. 92-106.
7.	Ramos HC， Todo S， Kang Y， et al. Liver transplantation without the use of blood products. Arch Surg， 1994， 129 （5）：528-533.
8.	Corwin HL， Parsonnet KC， Gettinger A. RBC transfusion in the ICU. Is there a reason ? Chest， 1995， 108 （3）：767-771.
9.	Atabek U， Alvarez R， Pello MJ， et al. Erythropoetin accelerates hematocrit recovery in post-surgical anemia. Am Surg， 1995， 61 （1）：74-77.
10.	Dudrick SJ， O'Donnell JJ， Raleigh DP， et al. Rapid restoration of red blood cell mass in severely anemic surgical patients who refuse transfusion. Arch Surg， 1985， 120 （6）：721-727.
11.	Martyn V， Farmer S. Two cases of iron deficiency. Bloodless Surg Update， 2000， 4 （1）：8.
12.	Brimacombe J， Skippen P， Talbutt P. Acute anaemia to a haemog-lobin of 14 g/l with survival. Anaesth Intensive Care， 1991， 19 （4）：581-583.
13.	Vamvakas EC， Blajchman MA. Deleterious clinical effects of transfusion-associated immunomodulation：fact or fiction ? Blood， 2001， 97 （5）：1180-1195.
14.	Hebert PC， Chin-Yee I. Clinical consequences of prolonged blood storage：should old red cells be transfused in critically ill patients ? TATM， 2001， 3 （2）：19-25.
15.	Vamvakas EC， Carven JH. Allogeneic blood transfusion， hospital charges， and length of hospitalization：A study of 487 consecutive patients undergoing colorectal cancer resection. Arch Pathol Lab Med， 1998， 122 （2）：145-151.
16.	Moraca RJ， Wanamaker KM， Bailey SH， et al. Strategies and outc-omes of cardiac surgery in Jehovah's Witnesses. J Card Surg， 2011， 26 （2）：135-143.
17.	Jassar AS， Ford PA， Haber HL， et al. Cardiac surgery in Jehovah's Witness patients：ten-year experience. Ann Thorac Surg， 2012， 93 （1）：19-25.
18.	Saczkowski R， Bernier PL， Tchervenkov CI， et al. Retrograde auto-logous priming and allogeneic blood transfusions：a meta-analysis. Interact Cardiovasc Thorac Surg， 2009， 8 （3）：373-376.
19.	Mangano DT， Tudor IC， Dietzel C. Multicenter study of perioperative ischemia research group；ischemia research and education foundation. The risk associated with aprotinin in cardiac surgery. N Engl J Med， 2006， 354 （4）：353-365.
20.	Wang G， Bainbridge D， Martin J， et al. The efficacy of an intraoperative cell saver during cardiac surgery：a meta-analysis of randomized trials. Anesth Analg， 2009， 109 （2）：320-330.
21.	Shalabi RI， Amin M， Ayed AK， et al. Delayed sternal closure is a Life saving decision. Ann Thorac Cardiovasc Surg， 2002， 8 （4）：220-223.
22.	Durandy Y. Perfusionist strategies for blood conservation in pediatric cardiac surgery. World J Cardiol， 2010， 2 （2）：27-33.
23.	van Son JA， Hovaguimian H， Rao IM， et al. Strategies for repair of congenital heart defects in infants without the use of blood. Ann Thorac Surg， 1995， 59 （2）：384-388.
24.	Miyaji K， Kohira S， Miyamoto T， et al. Pediatric cardiac surgery without homologous blood transfusion， using a miniaturized bypass system in infants with lower body weight. J Thorac Cardiovasc Surg， 2007， 134 （2）：284-289.
25.	McMillan D， Brady P， Foot C， et al. The team focus on improving blood transfusion. J Extra Corpor Technol， 2011， 43 （1）：65-67.

1. 　Ott DA， Cooley DA. Cardiovascular surgery in Jehovah's Witnesses. Report of 542 operations without blood transfusion. JAMA， 1977， 238 （12）：1256-1258.
2. 　Spahn DR， Casutt M. Eliminating blood transfusions：new aspects and perspectives. Anesthesiology， 2000， 93 （1）：42-55.
3. 　Rosengart TK， Helm RE， DeBois WJ， et al. Open heart operations without transfusion using a multimodality blood conservation strategy in 50 Jehovah's Witness patients：implications for a “bloodless” surg-ical technique. J Am Coll Surg， 1997， 184 （6）：618-629.
4. 　Helm RE， Rosengart TK， Gomez M， et al. Comprehensive multimo-dality blood conservation：100 consecutive CABG operations without transfusion. Ann Thorac Surg， 1998， 65 （1）：125-136.
5. 　Goodnough LT， Skikne B， Brugnara C. Erythropoietin， iron， and erythropoiesis. Blood， 2000， 96 （3）：823-833.
6. 　Salem MR， Manley S. Blood conservation techniques. In：Ramez Salem M， editor. Blood conservation in the surgical patient. London：Williams and Wilkins， 1996. 92-106.
7. 　Ramos HC， Todo S， Kang Y， et al. Liver transplantation without the use of blood products. Arch Surg， 1994， 129 （5）：528-533.
8. 　Corwin HL， Parsonnet KC， Gettinger A. RBC transfusion in the ICU. Is there a reason ? Chest， 1995， 108 （3）：767-771.
9. 　Atabek U， Alvarez R， Pello MJ， et al. Erythropoetin accelerates hematocrit recovery in post-surgical anemia. Am Surg， 1995， 61 （1）：74-77.
10. 　Dudrick SJ， O'Donnell JJ， Raleigh DP， et al. Rapid restoration of red blood cell mass in severely anemic surgical patients who refuse transfusion. Arch Surg， 1985， 120 （6）：721-727.
11. 　Martyn V， Farmer S. Two cases of iron deficiency. Bloodless Surg Update， 2000， 4 （1）：8.
12. 　Brimacombe J， Skippen P， Talbutt P. Acute anaemia to a haemog-lobin of 14 g/l with survival. Anaesth Intensive Care， 1991， 19 （4）：581-583.
13. 　Vamvakas EC， Blajchman MA. Deleterious clinical effects of transfusion-associated immunomodulation：fact or fiction ? Blood， 2001， 97 （5）：1180-1195.
14. 　Hebert PC， Chin-Yee I. Clinical consequences of prolonged blood storage：should old red cells be transfused in critically ill patients ? TATM， 2001， 3 （2）：19-25.
15. 　Vamvakas EC， Carven JH. Allogeneic blood transfusion， hospital charges， and length of hospitalization：A study of 487 consecutive patients undergoing colorectal cancer resection. Arch Pathol Lab Med， 1998， 122 （2）：145-151.
16. 　Moraca RJ， Wanamaker KM， Bailey SH， et al. Strategies and outc-omes of cardiac surgery in Jehovah's Witnesses. J Card Surg， 2011， 26 （2）：135-143.
17. 　Jassar AS， Ford PA， Haber HL， et al. Cardiac surgery in Jehovah's Witness patients：ten-year experience. Ann Thorac Surg， 2012， 93 （1）：19-25.
18. 　Saczkowski R， Bernier PL， Tchervenkov CI， et al. Retrograde auto-logous priming and allogeneic blood transfusions：a meta-analysis. Interact Cardiovasc Thorac Surg， 2009， 8 （3）：373-376.
19. 　Mangano DT， Tudor IC， Dietzel C. Multicenter study of perioperative ischemia research group；ischemia research and education foundation. The risk associated with aprotinin in cardiac surgery. N Engl J Med， 2006， 354 （4）：353-365.
20. 　Wang G， Bainbridge D， Martin J， et al. The efficacy of an intraoperative cell saver during cardiac surgery：a meta-analysis of randomized trials. Anesth Analg， 2009， 109 （2）：320-330.
21. 　Shalabi RI， Amin M， Ayed AK， et al. Delayed sternal closure is a Life saving decision. Ann Thorac Cardiovasc Surg， 2002， 8 （4）：220-223.
22. 　Durandy Y. Perfusionist strategies for blood conservation in pediatric cardiac surgery. World J Cardiol， 2010， 2 （2）：27-33.
23. 　van Son JA， Hovaguimian H， Rao IM， et al. Strategies for repair of congenital heart defects in infants without the use of blood. Ann Thorac Surg， 1995， 59 （2）：384-388.
24. 　Miyaji K， Kohira S， Miyamoto T， et al. Pediatric cardiac surgery without homologous blood transfusion， using a miniaturized bypass system in infants with lower body weight. J Thorac Cardiovasc Surg， 2007， 134 （2）：284-289.
25. 　McMillan D， Brady P， Foot C， et al. The team focus on improving blood transfusion. J Extra Corpor Technol， 2011， 43 （1）：65-67.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Bloodless Surgery and Its Application in Cardiac Surgery

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