Bloodless (Transfusion-free) Heart Surgery

Since open-heart surgery evolved into a routinely performed procedure, the vast majority of patients undergoing it have received blood transfusions. That was especially important when heart-lung machines were extremely large and required extra blood for priming. Through the years, however, a change has occurred-especially at leading heart centers such as Saint John's.

Now, patients at the Saint John's Transfusion-Free Medicine & Surgery program can undergo open-heart surgery without blood transfusion. It's a practice that continues to grow in acceptance among patients and their families.

In bloodless surgery there are two goals with regard to bleeding: to minimize the loss of blood, and to prevent serious bleeding problems. Prevention is the more challenging of the two because heparin, a time-proven anticoagulant, continues in use as physicians intervene with the clotting mechanism.

Traditionally, surgeons use a large incision in open-heart surgery, then attempt to minimize bleeding as it occurs. With bloodless surgery, even more efficiency is required. Electrocautery and advanced technology, including use of an argon beam coagulator-a surgical tool using argon gas along with electrocautery to promote clotting and limit blood loss during surgery-are important devices used to control bleeding. However, overall philosophy is also important: a total approach to minimizing bleeding is required before, during and after surgery.
    
There are many reasons to perform bloodless surgery. In open-heart surgery, there is always a chance of blood-borne disease developing even though the likelihood is minimized by stringent testing of the blood supply.

Patients who receive transfusions also face the possibility of lung inflammation, which can require them to remain on a ventilator and result in longer hospitalization. Bloodless surgery reduces the possibility that these and other complications will develop.

Blood supply considerations also are important. Periodically, blood donations fall to dangerous levels. When the overall supply is down, patients undergoing surgery face a variety of measures. These include postponement of procedures and donation of their own blood or that of family members in the event that blood is needed during a procedure. Bloodless surgery minimizes the necessity of both measures.

For many years, Saint John's Health Center has remained at the forefront of bloodless surgery. It's an accomplishment that continues to result in improved outcomes for our many patients.