Penn Leads in Transfusion Free Heart Surgery

Penn Medicine has a long history of pioneering advanced surgical techniques. Bloodless cardiac surgery is just one of those surgical advances. The Bloodless Cardiac Surgery Program at Pennsylvania Hospital is one of the few bloodless programs in the nation to offer a full array of cardiac procedures, including complex heart surgery. Surgeons from around the world, including four cardiac surgeons recently visiting from Beijing China, have worked with Penn surgeons to observe and learn about bloodless cardiac surgery.

The complexities of performing bloodless cardiac surgery require meticulous surgical technique. From preparation through recovery, successful bloodless surgery requires the talents of a very experienced, multispecialty team. Penn cardiovascular surgeons have mastered the exact level of skill and precision necessary to perform bloodless procedures. They successfully perform the most complex and intricate surgeries using bloodless strategies, and in fact, have helped design some of these processes and techniques.

“We have to be fast and precise,” said Charles R. Bridges, MD, ScD, chief of cardiovascular surgery at Pennsylvania Hospital. “In bloodless surgery, any post-surgical bleeding is unacceptable so our radar is finely tuned to recognize and address any potential bleeding issues.”

Bloodless surgery, also known as “transfusion-free” surgery, is performed without the use of stored or donated blood products. It also involves special pre-operative and post-operative blood management techniques to minimize blood loss.

Why Bloodless?
Interest in blood conservation techniques is growing around the world. Some patients do not want blood products used during surgery because of their religious beliefs. In third-world countries, blood supplies are limited and the blood that is available has not been subjected to the same safety measures employed in the U.S. In addition, emerging research shows that blood transfusions can put patients at higher risk for complications including infection, kidney failure and death, according to Dr. Bridges. These results point to the conservation of blood during cardiac surgery when it can be done safely.

“The consensus is, blood use does impact surgical success,” Dr. Bridges said. “A blood transfusion is a type of transplant. It promotes inflammation and an immune reaction. Heart patients are already vulnerable because of the stress from surgery so a transfusion is a double hit. We now have unequivocal evidence that unnecessary blood transfusions are harmful to patients.”

Dr. Bridges said more than 90 percent of the cardiac surgeries performed at Pennsylvania Hospital can be performed without the use of blood products.

“At Pennsylvania Hospital we are doing increasingly complex procedures following blood conserving techniques including the largest series of reoperative cardiac surgery (second-time heart surgery) and complex aortic surgeries in the country. Our goal is to perform all procedures using bloodless techniques when it can be done safely,” he said.

Benefits of bloodless cardiac surgery include:
§ Fewer complications related to transfusions.
§ Faster recovery time
§ Shorter hospital stay
§ Less chance of infection
§ Faster healing time for wounds

Blood Conserving Techniques
Every member of the cardiovascular team involved with patient care follows meticulous blood conservation protocols beginning before admission and continuing throughout the patients stay in the hospital.

Before surgery, patients see a member of the bloodless medicine staff. Hemoglobin levels are checked and any anemia is managed before surgery. If catheterization is needed in addition to surgery, it is performed several days before the surgery to allow patients’ hemoglobin levels to return to normal.

During surgery, up to three units of patient blood is held, separately but still connected, and protected from the heart-lung machine. This protects the blood and its components and provides fresh blood for use following the surgery. In addition, a mini heart-lung circuit is used, reducing the amount of saline that is used. Saline dilutes the blood.

“Meticulous surgical technique also helps reduce blood loss,” Dr. Bridges said. “The less time a patient is on the heart-lung machine, the less blood that is lost.”

Post surgery, Dr. Bridges said blood is not routinely drawn from patients, but only when it is necessary for patient care. When blood is taken for testing, pediatric tubes that hold less blood are used.

For more information about bloodless cardiac surgery or to schedule an appointment, please call 800-789-PENN (7366) or visit PennMedicine.org.