Bloodless Heart Surgery is not a familiar concept in any cardiac surgery center. Most heart surgeons have been trained under the assumption that blood products can be liberally transfused in their patients during and after an open heart operation. It is not surprising to find out that the average cardiac surgical service has transfusion rates of around 85% to 90%. Unfortunately, there is a price to pay for these transfusions. There are in fact a number of disadvantages and complications related to the use of blood products:
Our interest in bloodless heart surgery originated years ago from our efforts to offer a life saving heart operation to Jehovah's witnesses who would not accept a blood transfusion under any circumstances , even at the risk of severe complications or death. We learned very quickly that safe bloodless heart surgery was possible in the vast majority of cases. Here are the most important strategies that help us avoid the use of blood products:
- Transfusion reactions can be violent and life threatening immunologic responses caused by the blood products themselves or the additives and preservatives contained in the stored blood from the blood bank
- Fluid retention in the lungs, kidneys, brain, heart muscle, intestines and soft tissues can seriously slow down and affect the recovery of patients after open heart surgery and multiple blood transfusions
- Many patients are very uncomfortable about getting "other people's blood"
- Many patients fear getting HIV or Hepatitis infections carried in donated blood. This is really unlikely to happen because of our careful screening of each unit of blood. A theoretical concern has to do with the possibility that a new virus that has not been discovered yet would obviously go undetected. That's how many patients got HIV or Hepatitis C infection from blood transfusions years ago, when these two viruses were still unknown to the medical community
- Shortage of blood products in the blood banks caused by unnecessary use of blood products in elective surgery can jeopardize patients who really need blood in true emergencies (i.e.: trauma patients who are bleeding)
We quickly realized that bloodless surgery techniques should be adopted on every patient, regardless of religious convictions because patients were doing better with this approach. Their recovery was faster and the risks and complications related to blood transfusions were eliminated. The transfusion rates in reputable bloodless heart surgery centers are about 10%, nine times less than the average cardiac surgery center!!
- Patients are prepared by increasing their blood "thickness" with medications, iron and vitamins prior to surgery
- All medications and dietary supplements that can cause bleeding are suspended before surgery if medically safe
- Surgery is carried out in a very meticulous way to prevent any unnecessary bleeding during or after the operation
- No routine, unnecessary blood tests are drawn from patients after the surgery
More and more patients are becoming aware of this option and are willing to travel to centers that are offering these surgical services. Their answer to my title question is for them a no-brainer. Faced with a choice, they would rather have NO blood transfusion and a faster recovery without the problems caused by the use of blood products. If you or a loved one need open heart surgery consider inquiring about these better options in a minimally invasive and bloodless heart surgery center.
Giovanni B. Ciuffo, MD
Attending Cardiothoracic Surgeon
Minimally Invasive and Bloodless
Heart Surgery Center
Mount Sinai Hospital