Blood Transfusion in Cardiac Surgery: A highly Varied Practice

Cardiac surgery leapt forward decades ago with the advent of cardiopulmonary bypass. This technique allowed the adoption of surgical therapies for a number of life-threatening cardiac conditions, including coronary artery disease and cardiac valve disorders. A recent update on cardiac surgery activity reported that approximately 699,000 open heart procedures (valve operations, coronary artery bypass grafting [CABG], and others) were performed in 2005 in the United States.1

Blood use has been a major consideration for these procedures since the beginning of cardiopulmonary bypass. Over the years, advances in cardiopulmonary circuits and blood management have led to reduced blood use. Ott and Cooley2 promoted the use of crystalloid prime, which markedly diminished blood transfusion in the 1960s from an absolute requirement to an unneeded option in select patients, for example, those with religious beliefs barring blood transfusion. Nevertheless, many patients undergoing cardiac surgery receive blood transfusions.