Asanguineous Cardiopulmonary Bypass in Infants: Impact on Postoperative Mortality and Morbidity

Objectives: We routinely start cardiopulmonary bypass (CPB) for congenital heart surgery without homologous blood, due to circuit miniaturization and blood-saving measures. Blood transfusion is applied if hemoglobin concentration falls under 8 g/dL, or it is postponed to after coming off bypass or after operation. How this strategy impacts on postoperative mortality and morbidity in infants weighing ≤7 kg?

Methods: In this study, 615 open-heart procedures performed from 2014 to June 2018 were selected; 163 patients (26·5%) were transfused on CPB (group 1), and 452 (73·5%) patients were not transfused on CPB (group 2). Operative risk and complexity were similar in both groups. Postoperative mortality and morbidity were compared. Multiple logistic regression was used to detect factors independently associated with outcome.

Results: Observed mortality in nontransfused group (0.7% = 3/452) was significantly lower than expected (4.2% = 19/452); p = 0·0007, and much lower than in transfused group (6.7% = 11/163); p < 0·0001. CPB transfusion (p = 0·001) was independently associated with mortality, either acting as the sole factor or in combination with the Society of Thoracic Surgeons morbidity score (p = 0·013). Patients not transfused during CPB required less frequently vasoactive drugs (p = 0·011) and duration of their mechanical ventilation was shorter (93 ± 134 hours) than for transfused patients (142 ± 170 hours); p = 0·0003. CPB transfusion was an independent determinant factor for morbidity (p = 0.05), together with body weight (p < 0.0001), vasoactive inotrope score (p < 0.0001), CPB duration (p = 0.001), and postoperative transfusion (p = 0.009).

Conclusion: The strategy of transfusion-free CPB course, feasible in most patients ≤ 7 kg, was associated with improved outcome. Asanguineous priming of CPB circuit could be implemented routinely, even in neonates and infants.