Clinical Research And Exploration Of Children Cardiac Bloodless Surgery

Objective: By reviewing the clinical practice of perioperative blood products management in children undergoing cardiac surgery for congenital heart disease(CHD)in the past 3 years at our institution,we compared the influence of cardiac bloodless surgery and cardiac surgery with blood on postoperative recovery and incidence of complications in children,and explored the feasibility,safety,and importance of performing bloodless heart surgery in children with simple CHD,to improve the prognosis of children,enhance perioperative blood management of children with CHD and improve medical quality.Materials & Methods: The first part: 99 patients with simple CHD who had undergone mild anemia before radical surgery at our institution from February 2014 to February 2016(eventually divided into bloodless surgery group(n=87)and intraoperative transfusion group(n=12))were enrolled,and their general preoperative condition,information of perioperative blood gas analysis and postoperative recovery were retrospectively analyzed.The second part: 90 infants and children with simple CHD who underwent surgery with CPB at our institution fromMarch 2016 to October 2016(bloodless surgery group(n=30),surgery with blood group(n = 60))were enrolled.And preoperative condition,perioperative blood gas analysis information and postoperative data of 24 hours drainage,the ventilation time,the ICU stay days,pacemaker usage,major complications(e.g.capillary leak syndrome,pulmonary edema,cardiac insufficiency,arrhythmia,coagulopathy,infection,hypoproteinemia,impaired liver function,and stress ulcer),and postoperative blood transfusions were analyzed.Results: The first part: There was no significant difference in preoperative general and perioperative blood gas analysis parameters between 2 groups,and no significant difference was found in the postoperative ventilation time,24 h drainage,ICU stay time and postoperative hospital stay(p values were 0.852,0.912,0.216,and 0.841,respectively).The second part: There was a significant difference in ventilator use time and ICU stay time between 2 groups(P<0.05),while there was no significant difference in postoperative complications.however some mild differences were noticed: the proportion of coagulopathy was higher in the blood group,and the temporary pacemaker usage,pulmonary edema,cardiac insufficiency,off-line failure,liver function damage,stress ulcer only occurred in the transfusion group.Conclusion: For children with simple CHD and mild anemia,it's proven safe and feasible to conduct bloodless surgery.To avoidperioperative blood transfusion,although many researchers suggest optimizing hemoglobin level at least to normal value,our experience concluded that hemoglobin optimization could have a not so strict standard to balance the risk of progression of disease and preoperative anemia in transfusion-free surgery.In addition,for children with simple CHD,intraoperative blood transfusion is related to large postoperative drainage and long ICU stay,and the risk of postoperative complications maybe higher in the transfusion group.Moreover,accurate assessment of anemia and transfusion indication during pediatric cardiac surgery could further reduce allogenic transfusion and relieve blood shortage.In short,the study of perioperative blood management in children with CHD is necessary to improve their prognosis,clinically reasonable use of blood and optimize the distribution of medical resources.