The impact of partial blood replacement on postoperative outcome for pediatric patients with cyanotic heart disease

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Mohammad Saleh*

Abstract



Background: Pediatric patients with cyanotic congenital heart disease who underwent open heart corrective surgery, were unfortianetly suffering from postoperative clinical deterioration which may leads to morbidity and mortality. Most of blood transfusion indications are now well managed exclusively with blood component therapy, however concerns about logistics, safety, and relative efficacy making the blood transfusion a debating procedure in many cardiac centers around the world. The research aimed to investigate the partial blood replacement process for cyanotic pediatric patients by healthy RBCs (red blood cells), solving their postoperative clinical deterioration and proving that the RBCs membrane biomechanical characteristics alterations is the main cause of the adverse effects of prolonged hypoxia on the normal physiological functions of RBCs in oxygen transport and body tissue’s perfusion.


Methods: 450 Pediatric patients with congenital heart disease were divided into three equal groups, group I acyanotic pediatric patients, group II cyanotic pediatric patients and group III cyanotic pediatric patients treated with the partial blood replacement process. Blood components biophysical characteristics and cardiovascular performance were investigated and the postoperative clinical course was estimated.


Results: The results showed the improvement of group III pediatrics, as there were insignificant decrease in blood components characteristics, cardiovascular performance and postoperative clinical course estimation compared to group I.


Conclusion: The partial blood replacement process after cardiopulmonary bypass procedure for pediatric patients with cyanotic congenital heart disease who undergo corrective congenital surgery, may help in improving their postoperative clinical course and outcomes.



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Article Details

Saleh, M. (2020). The impact of partial blood replacement on postoperative outcome for pediatric patients with cyanotic heart disease. Journal of Cardiovascular Medicine and Cardiology, 7(2), 167–188. https://doi.org/10.17352/2455-2976.000134
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Copyright (c) 2020 Saleh M.

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O’Brien P and Smith PA (1994) chronic hypoxemia in children with cyanotic heart disease. Crit Care Nurs Clin North Am 6: 215-226. Link: https://bit.ly/3gCiJOS

Dosanjh A (2018) Neonatal Cyanosis: A Clinical Diagnosis. EC Paediatrics 12: 1164-1168. Link: https://bit.ly/2XLSxJ0

Komarlu R, Morell VO, Kreutzer J, Munoz RA (2010) Dextro-Transposition of the Great Arteries. In: Munoz RA, Morell VO, da Cruz EM, Vetterly CG and da Silva JP, editors. Critical care of children with heart disease: basic medical and surgical concepts. 2nd ed. Switzerland: Springer, 2010. pp. 359-377. Link: https://bit.ly/2ZzdfO0

Samarasinghe D (2010) Congenital heart disease: When to act and what to do?. Sri Lanka Journal of Child Health 39: 39-43. Link: https://bit.ly/2Woirm8

Redlin M, Kukucka M, Boettcher W, Schoenfeld H, Huebler M, et al. (2013) Blood transfusion determines postoperative morbidity in pediatric cardiac surgery applying a comprehensive blood-sparing approach. J Thorac Cardiovasc Surg 146(3): 537-542. Link: https://bit.ly/2WoZLmc

Şahutoğlu C, Yaşar A, Kocabaş S, Zekiye Aşkar F, Fatih Ayık M, et al. (2018) Correlation between serum lactate levels and outcome in pediatric patients undergoing congenital heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg 26: 375-385. Link: https://bit.ly/32ly2qa

Zhang Y, Zhang X, Wang Y, Shi J, Yuan S, et al. (2019) Efficacy and Safety of Tranexamic Acid in Pediatric Patients Undergoing Cardiac Surgery: A SingleCenter Experience. Front Pediatr. 7;7: 181. Link: https://bit.ly/2ZzdfO0

Awad H, El-Safty I, Abdel-Gawad M, El-Said S (2003) Glomerular and tubular dysfunction in children with congenital cyanotic heart disease: effect of palliative surgery. Am J Med Sci. 325(3): 110-114. Link: https://bit.ly/30g92xZ

Morgan C, Al-Aklabi M, Guerra GG (2015) Chronic kidney disease in congenital heart disease patients: a narrative review of evidence. Can J Kidney Health Dis 2: 27. Link: https://bit.ly/3dd42zF

Dittrich S, Kurschat K, Dähnert I, Vogel M, Müller C, et al. (2000) Renal function after cardiopulmonary bypass surgery in cyanotic congenital heart disease. Int J Cardiol 73: 173-179. Link: https://bit.ly/36DUmLU

Fogo AB (2014) Pediatric Renal Pathology. Pediatric Nephrology, SpringerVerlag Berlin Heidelberg. Link: https://bit.ly/3dcOzQ5

Goel M, Shome DK, Singh ZN, Bhattacharjee J, Khalil A (2000) Haemostatic changes in children with cyanotic and acyanotic congenital heart disease. Indian Heart J 52: 559-563. Link: https://bit.ly/2zG4FTF

Horigome H, Hiramatsu Y, Shigeta O, Nagasawa T, Matsui A (2002) Overproduction of Platelet Microparticles in Cyanotic Congenital Heart Disease With Polycythemia. J Am Coll Cardiol 39: 1072-1077. Link: https://bit.ly/30grqGV

Murni IK, Djer MM, Yanuarso PB, Putra ST, Advani N, et al. (2019) Outcome of pediatric cardiac surgery and predictors of major complication in a developing country. Ann Pediatr Card. 12(1): 38-44. Link: https://bit.ly/36Eznso

Penna GL, Salgado DR, Japiassú AM (2011) Microcirculatory assessment: a new weapon in the treatment of sepsis? Rev Bras Ter Intensiva 23(3): 352-357. Link: https://bit.ly/2ZU0fmG

Trzeciak S, McCoy JV, Dellinger P, Arnold RC, Rizzuto M, et al. (2008) Early Increases in Microcirculatory Perfusion During Protocol-Directed Resuscitation are Associated with Reduced Multi-Organ Failure at 24 hours in Patients with Sepsis. Intensive Care Med 34(12): 2210-2217. Link: https://bit.ly/3ezRxho

Trivelli LA, Ranney HM, Lai HT (1971) Hemoglobin components in patients with diabetes mellitus. N Engl J Med 284: 353-357. Link: https://bit.ly/2McGNti

Parpart AR, Lorenz PB, Parpart ER, Gregg JR, Chase AM (1947) The osmotic resistance (fragility) of human red cells. J Clin Invest 26: 636-640. Link: https://bit.ly/3eG24rv

Kronig R (1926) On the theory of the dispersion of x-rays. J Opt Soc Am 12: 547-557. Link: https://bit.ly/2C6kV1D

Rabbat C, Treleaven D, Russell J, Ludwin D, Cook D (2003) Prognostic value of myocardial perfusion studies in patients with end-stage renal disease assessed for kidney or kidney-pancreas transplantation: a meta-analysis. J Am Soc Nephrol 14(2):431-439. Link: https://bit.ly/3jajEHd

Kula B, Zingle N (2009) Optimizing Circuit Design Using a Remotemounted Perfusion System. J Extra Corpor Technol 41(1): 28-31. Link: https://bit.ly/2WmY3BI

Shin’oka T, Shum-Tim D, Jonas RA, Lidov HG, Laussen PC, et al. (1996) Higher hematocrit improves cerebral outcome after deep hypothermic circulatory arrest. J Thorac Cardiovasc Surg 112: 1610-1621:Link: https://bit.ly/2B5oHHs

Duncana BW, Meea RB, Mesia CI, Qureshi A, Rosenthal GL, et al. (2003) Results of the double switch operation for congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg 24: 11-20. Link: https://bit.ly/2XyqDzK

Chang AC, McKenzie ED (2005) Mechanical cardiopulmonary support in children and young adults: extracorporeal membrane oxygenation, ventricular assist devices, and long-term support devices. Pediatr Cardiol 26: 2-28. Link: https://bit.ly/2ZuVorA

Durandy YD, Younes M, Mahut B (2008) Pediatric Warm Open Heart Surgery and Prolonged Cross-Clamp Time. Ann Thorac Surg 86: 1941-1947. Link: https://bit.ly/32qjEgq

Bishnoi AK, Garg P, Patel K, Solanki P, Surti J, et al. (2017) Effect of Prime Blood Storage Duration on Clinical Outcome After Pediatric Cardiac Surgery. World J Pediatr Congenit Heart Surg 8: 166-1673. Link: https://bit.ly/3chnjON

Mousa SO (2020) Red blood cell transfusion in preterm neonates: a huge debate on tiny patients. Annals of Neonatology Journal 2: 5-13. Link: https://bit.ly/32qjEgq

Shanmugha Priya RA, Krishnamoorthy R, Panicker VK, NinanB (2018) Transfusion support in preterm neonates <1500 g and/or <32 weeks in a tertiary care center: A descriptive study. Asian J Transfus Sci 12: 34-41. Link: https://bit.ly/2DHHlq9

Patil V, Shetmahajan M (2014) Massive transfusion and massive transfusion protocol. Indian J Anaesth 58: 590–595. Link: https://bit.ly/3gvEek5

Goldstein SL (2003) Overview of pediatric renal replacement therpy in acute renal failure. Artif Organs 27: 781-785. Link: https://bit.ly/2TOWXxz

Luckritz KE, Symons JM (2009) Renal replacement therapy in the ICU. In: Kiessling SG, Goebel J and Somers MJG, editors. Pediatric Nephrology in the ICU. Spain: Springer 115-126.

Murthy KS, Reddy KP, Nagarajan R, Goutami V, Cherian KM (2010) Management of ventricular septal defect with pulmonary atresia and major aorto pulmonary collateral arteries: Challenges and controversies. Ann Pediatr Cardiol 3(2): 127– 135: Link: https://bit.ly/2CCwe1h

McElhinney DB, Reddy VM, Hanley FL (1998) Tetralogy of Fallot with Major Aortopulmonary Collaterals: Early Total Repair. Pediatr Cardiol 19(4): 289-296. Link: https://bit.ly/392JmsU

Como JJ, Dutton RP, Scalea TM, Edelman BB, Hess JR (2004) Blood transfusion rates in the care of acute trauma. Transfusion 44(6): 809813. Link: https://bit.ly/2WkRCz6

Pouard P (2005) Blood Conservation in Pediatric Cardiac Surgery. TATM 7: 58-62. Link: https://bit.ly/2OtE7ZB

Strauss RG (2004) Red blood cell transfusion in the neonate, infant, child, and Adolescent. In: Hillyer CD, Strauss RG and Luban NLC. Editors. Handbook of pediatric transfusion medicine. USA: Academic Press, pp. 131-136. Link: https://bit.ly/32o9JYE

McMullin NR, Holcomb JB, Sondeen J (2006) Hemostatic Resuscitation. In: Vincent JL. (eds) Yearbook of Intensive Care and Emergency Medicine. Yearbook of Intensive Care and Emergency Medicine. Berlin: Springer 265–278.

Hornykewycz SJ, Odegard KC, Castro R, DiNardo JA (2006) Infant CPB: Effect of Refrigerated Whole Blood Prime on Platelet Count and Fibrinogen. Pediatric Critical Care Medicine 7(6): S28. Link: https://bit.ly/36G2gEw

Bruley DF (2007) Anticoagulant blood factor deficiencies (protein C). In J. Maguire Duane F. Bruley David K. Harrison (Eds.) Oxygen Transport to Tissue XXVIII David. (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013 USA) 599: 1-6. Link: https://bit.ly/2zGbbKa

Repine TB, Perkins JG, Kauvar DS, Blackborne L (2006) The use of fresh whole blood in massive transfusion. J Trauma 60(6 Suppl): S59– S69. Link: https://bit.ly/2ZvtQ5x

Cassella D, Appenzeller G, Stich J (2009) From Donor to Patient in 20 Minutes, Emergency Resuscitation With Whole Blood During Operation Iraqi Freedom. Critical Care Nurse 29(2): 27-32. Link: https://bit.ly/3ezklq0

Mohr R, Martinowitz U, Lavee J, Amroch D, Ramot B, et al. (1988) The hemostatic effect of transfusing fresh whole blood versus platelet concentrates after cardiac operations. J Thorac Cardiovasc Surg 96(4): 530534. Link: https://bit.ly/2XTSISD

Duchesne JC, Hunt JP, Wahl G, Marr AB, Wang YZ, et al. (2008) Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years? J Trauma 65(2): 272-278. Link: https://bit.ly/397NJ5N

Kauvar DS, Holcomb JB, Norris GC, Hess JR (2006) Fresh Whole Blood Transfusion: A Controversial Military Practice. J Trauma 61(1): 181-184. Link: https://bit.ly/38ZSSwI

Hess JR, Thomas MJ (2003) Blood use in war and disaster: lessons from the past century. Transfusion 43(11): 1622-1633. Link: https://bit.ly/2CEPLhL

Maclennan S, Murphy MF (2001) Survey of the use of whole blood in current blood transfusion practice. Clin Lab Haematol 23(6): 391396. Link: https://bit.ly/3jaf0cz

Mabry RL, Holcomb JB, Baker AM, Cloonan CC, Uhorchak JM, et al. (2000) United States Army rangers in Somalia: an analysis of combat casualties on an urban battlefield. J Trauma 49(3): 515-528. Link: https://bit.ly/2Zyqw9S

Grosso SM, Keenan JO (2000) Whole Blood Transfusion for Exsanguinating Coagulopathy in a U.S. Field Surgical Hospital in Postwar Kosovo. J Trauma 49(1): 145-148. Link: https://bit.ly/30ffrJJ

Hardy J, Moerloose P, Samama M (2004) Massive transfusion and coagulopathy: pathophysiology and implications for clinical management. Can J Anesth 51(4): 293–310. Link: https://bit.ly/30jG2W4

Matthew J (2005) the effect of intermittent hypoxic exposure on haemorheology of Elite meddle distance runners. Mater thesis, school of physiotherapy and exercise science, Griffith University, Australia. Link: https://bit.ly/2Wq9RTU

Katayama Y, Horigome H, Murakami T, Takahashi-Igari M, Miyata D, et al. (2006) Evaluation of blood rheology in patients with cyanotic congenital heart disease using a microchannel array flow analyzer. Clin Hemorheol Microcirc. 35(4): 499-508. Link: https://bit.ly/36M53ft

Kameneva M, Ündar A, Antaki J, Watach MJ, Calhoon JH, et al. (1999) Decrease in red blood cell deformability due to effects of hypo-thermia, hemodilution, and mechanical stress: factors related to cardiopulmonary bypass. ASAIO J 45(4): 307–310. Link: https://bit.ly/36E0ZxX

Tsukihara T, Aoyama H (2000) Membrane protein assemblies - towards atomic resolution analysis. Curr Opin Struct Biol 10(2): 208-212. Link: https://bit.ly/2Wq9sRo

Peters LL, Shivdasani RA, Liu SC, Hanspal M, John KM, et al. (1996) Anion exchanger 1 (band 3) is required to prevent erythrocyte membrane surface loss but not to form the membrane skeleton. Cell 86(6): 917-927. Link: https://bit.ly/2C6jBvH

Becker V, Schilling M, Bachmann J, Baumann U, Raue A, et al. (2010) Covering a broad dynamic range: information processing at the erythropoietin receptor. Science (New York, N.Y.) 328: 1404-1408. Link: https://bit.ly/393vKNG

Martin OC, Pagano RE (1987) Transbilayer movement of fluorescent analogs of phosphatidylserine and phosphatidylethanolamine at the plasma membrane of cultured cells. Evidence for a protein-mediated and ATP-dependent process (es). J Biol Chem. 262(12): 5890-5898. Link: https://bit.ly/3d8TeCq

Khalid S, Baaden M (2010) Molecular dynamics studies of outer membrane proteins: a story of barrels. In: Sansom M and Biggin P editors. Molecular simulations and biomembranes from biophysics to function. Royal Society of Chemistry 225-247. Link: https://bit.ly/2ZzbGQ8

Kessel A, Ben-Tal N (2010) introduction to proteins: structure, function and motion. Membrane proteins. 2 nd edition, CRC Press Taylor & Francis Group pp. 415-437.

Yu G, Bolon M, Laird DW, Tyml K (2010) Hypoxia and reoxygenation-induced oxidant production increase in microvascular endothelial cells depends on connexin40. Free Radic Biol Med 49: 1008-1013. Link: https://bit.ly/38ZSAG8

Cooper GM (2000) The cell. A Molecular Approach, 2 nd edition. Sunderland (MA):Sinauer Associates. Link: https://bit.ly/3ddO5sF

Heerklotz H, Seelig J (2007) Leakage and lysis of lipid membranes induced by the lipopeptide surfactin. Eur Biophys J. 36(4-5): 305–314. Link: https://bit.ly/38ZoFha

Dathe M, Wieprecht T (1999) Structural features of helical antimicrobial peptides: their potential to modulate activity on model membranes and biological cells. Biochim Biophys Acta 1462: 71-87. Link: https://bit.ly/30hLAQW

Jeong Y. (2011) Introduction to Bioelectricity. In: Yoo HJ., van Hoof C. (eds) Bio-Medical CMOS ICs. Integrated Circuits and Systems. Springer, Boston, MA. Link: https://bit.ly/2ZxMdGY

Ali FM, Mohamed WS, Mohamed MR (2003) Effect of 50 Hz, 0.2 mT Magnetic Fields on RBC Properties and Heart Functions of Albino Rats. Bioelectromagnetics 24: 535-545. Link: https://bit.ly/3j8zr9B

Hamilton G, Mathura R, Allsop J, Forton DM, Dhanjal NS, et al. (2003) Changes in brain intracellular pH and membrane phospholipids on oxygen therapy in hypoxic patients with chronic obstructive pulmonary disease. Metab Brain Dis 18(1): 95-109. Link: https://bit.ly/3evpUG5

Maureen C, Jane M (2007) Calcium-independent phospholipase A2-catalyzed plasmalogen hydrolysis in hypoxic human coronary artery endothelial cells. Am J Physiol Cell Physiol 292: C251-C258. Link: https://bit.ly/3j6OxfO

Helszer Z, Jozwiak Z, Leyko W (1980) Osmotic fragility and lipid peroxidation of irradiated erythrocytes in the presence of radioprotectors. Experientia 36: 521-524. Link: https://bit.ly/30f6OPt

Vuong PN, Berry C (2005) The pathology of vessels. Capter I histology of vessels. France: Springer, pp. 1-25. Link: https://bit.ly/2CfUJBB

Galvis MM, Bhakta R, Mendez MD (2020) Cyanotic heart disease. StatPearls Publishing. Link: https://bit.ly/2M7AvLw

Kleinman CS, Seri I (2012) Hemodynamics and Cardiology: Neonatology Questions and Controversies. 2nd Edition USA: Elsevier, pp. 3-12.

Schwartz LI, Ing RJ, Twite MD (2014) Anesthetic Considerations for Children with Congenital Heart Disease Undergoing Non-cardiac Surgery. In: Da Cruz E., Ivy D., Jaggers J. (eds) Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. Springer, London 743-757. Link: https:// bit.ly/2TP2TXo