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What to Expect

Before surgery

Weeks before a bloodless procedure, physicians may prepare the patient by bolstering the patient’s hematocrit with iron supplements and sometimes medications. Patients typically meet with a physician a day or two before the surgery to make sure their hemoglobin level is high enough to make bloodless surgery a safe proposition. If for some reason a patient is anemic at that point, the bloodless component of the surgery may be cancelled. Blood draws during the pre-operative period are kept to a minimum. “We draw enough to conduct the necessary tests,” says Dr. Yarlagadda, “but we consider whether each draw is really essential. If we don’t need the blood, we leave it in the patient.”

During surgery

During all open cardiothoracic surgery, a bypass machine is used to keep blood oxygenated and pumping throughout the body while the heart and lungs are temporarily taken off line. Unlike traditional bypass machines that require a lot of blood to fill the long tubes carrying the blood from body to machine and back, bloodless surgery bypass machines use much shorter and narrower-gauge “circuits,” or tubes. The pump may even be worn by the surgeon like an under-the-arm holster so that it remains as close to the patient as possible, minimizing the amount of blood needed to operate the machine. Minimally invasive surgical strategies and technologies also make bloodless surgery feasible for very small patients. Meticulous technique and smaller incisions have always been valued in pediatric surgery, but the incentive to take full advantage of these assets is amplified by the benefits of minimizing blood loss.

Inevitably, some blood will be lost during surgery. When it is, it is vacuumed up and recycled using a “cell saver,” a machine that “cleans” the patient’s blood to remove any clots and then safely reintroduces it to the patient.

“During bloodless surgery, we are also meticulous about hemostasis,” says Dr. Maeda. New medications that quickly seal up the flow of blood from incisions have helped surgeons further reduce loss.

After surgery

Dr. Yarlagadda has drastically reduced the amount of blood drawn from patients in the Pediatric Intensive Care Unit after surgery so that they can return to their normal blood levels as quickly as possible. Traditionally, 2 mm to 7 mm of a patient's blood would be drawn 24 times a day. For a small child whose blood levels have been reduced by surgery, that is too much. If he is careful to draw only when necessary, however, Dr. Yarlagadda can reduce blood draws to three or four times a day right after surgery and then just once a day until discharge.

The advantages of bloodless surgery are significant enough — and well enough established — that they are quickly becoming the standard of care at the Betty Irene Moore Children’s Heart Center. “If you can get by without using donated blood,” says Dr. Yarlagadda, “why wouldn’t you?”