Managing bleeding in cardiac surgery

Despite major advances in the management of perioperative blood conservation, transfusion rates in cardiac surgery remain very high, with large variations among individual centres. Significant differences in the approach to allogeneic red cell transfusion have been consistently observed among institutions in particular in cardiac surgery. The concept of blood conservation rests on three main pillars: (i) Increasing preoperative red blood cell mass, (ii) Decreasing peri-operative blood losses, and (iii) Optimizing transfusion practice. The acceptance of a lower perioperative haematocrit (in IJN the Hct on bypass is 20-25% and post bypass is >25%) could present an important element in current blood conservation practice. Other techniques include pharmacological (tranaxemic acid, aprotinin, desmopressin, rFVII) as well as non pharmacological techniques (PAD, ANH, red cell washing, tissue glue) as well as novel surgical and cardiology techniques (Off Pump surgery, minimal invasive surgery, stenting and other interventions).