ObjectiveTo study the effectiveness of simplified blood management in cardiovascular surgery, minimize the need for blood transfusions and decrease the medical care costs. MethodsFrom March 2010 to May 2013, the simplified blood management was applied in 655 patients who underwent cardiovascular surgery in the department of cardiac surgery, Guangdong General Hospital. There were 316 males and 339 females with their age of 13-78 (45.0±13.8) years. The techniques of simplified blood management consisted of preoperative strategies, intraoperative strategies, and postoperative strategies. ResultsThere were 437 patients (66.7%) avoiding red cell transfusion in cardiac surgery. Of the 437 patients, 403 (61.5%) without any blood products transfusion, 29 had transfusion of plasma transfusion, 3 of plasma and cryoprecipitation, one of plasma and platelet, and one of platelet only. Two patients died within 30 days postoperative with 0.5% mortality rate:one died of multiple organ failure, one died of cardiac arrest. The procedures and special etiologies of 437 patients avoiding red cell transfusion included mitral valve replacement in 86 patients, double valve (aortic and mitral) replacement in 75 patients, aortic valve replacement in 51 patients, mitral valve replacement plus modified Maze procedure in 41 patients, atrial septal defect repair in 41 patients, mitral valve repair in 38 patients, double valve replacement plus modified Maze procedure in 25 patients, re-do operation in 23 patients, ventricular septal defect repair in 18 patients, coronary artery bypass grafting plus valve replacement in 10 patients, myxoma excision in 8 patients, subacute bacterial endocarditis in 8 patients, pericardium dissection in 5 patients, off-pump coronary artery bypass grafting in 4 patients, Bentall procedure in 4 patients. Of 65 patients with cardiac surgery history, 23 (35.4%) were free from red cell transfusion in the second operation. ConclusionSimplified blood management is of benefit to reduce the blood transfusion safely and effectively, no using additional expensive medication and medical devices and therefore without increasing hospital costs. The technique is suitable to any institute and patient. It is worthwhile to be used widely in clinical practice. Cell salvage system is not necessary.
Red blood cell (RBC) transfusions are frequently used in cardiac surgery. A minority of patients assume most of the blood products transfusion during and after cardiac operations. Observational analysis of transfusion in patients undergoing cardiac surgery has uniformly demonstrated that RBC transfusion is associated with a significantly increasing risk of all-cause mortality and other serious adverse outcomes. In addition, it is an established fact that such patients can tolerate relatively low hemoglubin (Hb) levels. Consequently, it becomes widely accepted that appropriate limitation of transfusions could confer a substantial benefit to patients and decrease the use of limited resource. As a result, a restrictive threshold for blood transfusion is likely to be favored under most circumstances. However, an increasing amount of data differing from the observational analysis shows that clinical outcomes in patients who received transfusions with restrictive thresholds for Hb level are not superior to those with liberal thresholds. It has created a new uncertainty regarding the use of a restrictive threshold for transfusion during the perioperative period of cardiac surgery.