Blood Use in Cardiac Surgery

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Cardiac surgery has evolved significantly since its inception in the mid-1950s. Advances in surgical techniques, extracorporeal circulation, and postoperative care have led to a notable decrease in morbidity and mortality rates. A crucial factor in this progress has been the use of homologous donor blood for blood substitution. Two decades ago, open-heart surgeries typically required an average of 8 units of preserved blood, largely due to early surgical practices, inadequate anticoagulation control, significant blood trauma from extracorporeal circulation, and the absence of technologies for retransfusing shed mediastinal blood. Innovations like normovolemic hemodilution, intraoperative autotransfusion, and postoperative return of shed blood have significantly lowered the need for donor blood. Nowadays, most routine coronary artery surgeries can be performed without any transfusions. However, patients undergoing complex valve surgeries or reoperations may still experience substantial blood loss, necessitating several transfusions. Consequently, blood conservation has become a critical focus for cardiac surgeons, driven by concerns over infectious complications associated with blood transfusions, particularly hepatitis and AIDS.