Open heart surgery without transfusion in high-risk patients

Recent innovations, both pharmacologic and mechanical, make possible the performance without blood transfusions of even complex open heart operations in patients with advanced disease. Preoperative red cell mass and postoperative chest-tube drainage are independent risk factors for transfusion. The key to avoiding the need for transfusion is to have an adequate red cell mass preoperatively and to avoid losing that red cell mass with surgical intervention. Our institution’s bloodless-surgery program includes the use of erythropoietin in patients who have inadequate red cell mass preoperatively, aprotinin to prevent or decrease the coagulopathy associated with open heart surgery, and a process of retrograde autologous priming to decrease the heart–lung machine’s dilution of blood with crystalloid solution. Based on a study of our experience, we use a hematocrit of 15% in most patients as our signal for transfusion during open heart surgery in patients without relevant comorbidity.