New developments in Patient Blood Management in cardiac surgery in France

In cardiac surgery, preoperative anemia concerns 20 to 30% of patients, leading to perioperative transfusion. Anemia and transfusion are recognized as independent factors of postoperative morbidity and mortality with severity and dose-dependent effects. Associated with postoperative bleeding, these three factors form a deadly triad. Patient Blood Management (PBM) programs have been developed and are based on three pillars: optimization of blood mass, minimization of blood loss and optimization of anemia tolerance including a blood transfusion strategy. The positive impacts on the quality of care provided to the patient (significant reduction of transfusion rates, of postoperative complications, of mortality, and length of hospital stays) but also its economic impact at the level of one institution, or even on national level, have been proven. In France, PBM programs, specifically in cardiac surgery, have not been as well developed, probably due to a lack of formation and information of medical community. The High Authority of Health has recently published national guidelines on PBM in cardiac surgery on the initiative of French national societies and PBM programs are now incorporated in enhanced recovery after surgery programs. This article provides a review of literature of PBM concept in cardiac surgery in France.