Fresh Whole Blood versus Reconstituted Blood for Pump Priming in Heart Surgery in Infants

Nearly 20,000 operations to repair congenital heart lesions are performed each year in the United States, and most are performed with the use of cardiopulmonary bypass. The bypass circuit needs to be primed before use, either with fresh whole blood or with blood that has been reconstituted from packed red cells and fresh-frozen plasma. This study, which compared the two priming methods, found that fresh whole blood offers no advantage over reconstituted blood and that its use may in fact be disadvantageous. Fresh whole blood offers no advantage over reconstituted blood, and it may in fact be disadvantageous. The deleterious effects of cardiopulmonary bypass increase the morbidity and mortality associated with surgery for congenital heart disease. Children undergoing cardiopulmonary bypass face the challenge of hemodilution and platelet dysfunction, which induce a state of abnormal coagulation. 1 , 2 This is particularly true in neonates, who commonly endure the equivalent of a complete exchange transfusion. 3 – 6 Cardiopulmonary bypass also exposes a patient's blood to the nonendothelialized surface of the bypass circuit. Such exposure provokes the elaboration of cytokines and complement activation. 7 , 8 This inflammatory response is associated with the development of capillary leak syndrome, generalized edema, myocardial injury, and multisystem organ . . .