Strategic and Operational Aspects of a Transfusion-Free Neonatal Arterial Switch Operation

Blood transfusion-free complex congenital cardiac surgery in a neonate
remains a challenge for multidisciplinary cardiac teams. At our
institution, a 3.5 kg neonate, born to a family of Jehovah’s Witnesses
and postnatally diagnosed with dextro-transposition of the great
arteries (d-TGA) and a small muscular ventricular septal defect,
underwent a successful arterial switch operation without blood or
platelet transfusion. Key points that contributed to success were
optimal preoperative haematopoetic conditioning using erythropoietin and
iron, a miniaturized cardiopulmonary bypass circuit including a low
prime volume oxygenator and crystalloid cardioplegia, and a
well-coordinated multidisciplinary team. We report an overview of the
literature regarding blood transfusion-free complex congenital cardiac
surgery.