The Miami Children’s Cardiac Program has an intense commitment to minimizing the trauma associated with congenital heart disease. Our focus is on exceptional surgical outcomes and minimizing the long-term morbidity of congenital heart disease using:
Innovative techniques, such as cerebral perfusion to minimize neurological trauma
Innovative enabling technologies such as intraoperative cardioscopy to allow smaller, less painful and more cosmetic incisions
Innovative collaborative approaches, working with interventional cardiologists in the operating room and the catheterization laboratory
Innovative information technologies, to measure our long-term success at minimizing trauma
We have focused a multidisciplinary team effort on minimizing the transfusion of blood and blood products in patients with congenital heart disease. Our innovative approach evaluates all patients for the potential need for transfusion of blood and blood products. Once the relative risk of transfusion is determined we work with each patient and family to determine the best strategy for avoiding or minimizing transfusion.. This individual approach allows every family to express their own level of concern with the transfusion of blood products. These concerns may range from medical concerns regarding the efficacy and risks of blood transfusion to religious concerns such as those held by patients of the Jehovah’s Witness faith. Our multidisciplinary program ensures that the risk of blood transfusion is minimized in every patient.
Multidisciplinary Program for Bloodless Surgery
Preoperative assessment of every patient
Innovative perfusion equipment including - Bloodless low volume prime circuit - Bloodless low volume prime support circuit - Cell saving technologies - Routine use of Aprotinen
Minimizing blood drawing with innovative technologies in the ICU (I-stat)
Focused cooperation and communication between team members patients and families
Availability of all techniques and technologies including - Directed donation - Autologous donation - Preoperative erythropoetin treatment - Minimization of any transfusion therapy
Perioperative Blood Management Strategies for All Patients
Pre-Operative Planning and Patient Risk Assessment
Set level of anemia tolerated by team
Assess bleeding risk
Coagulation profile
Determine RBC mass
Assess patient/family desire for pastoral care
Optimizing RBC mass
Iron
Vitamin B12
Folic Acid
Erythropoietin (10-21 Days Pre-Surgery)
Minimizing Blood Loss
Operative positioning of patient
Maintain normothermia
Pre-Bypass hemodilution / Phlebotomy
Hypotension <SVR
Trasylol (Aprotinen) Routinely
Cell saver
Fibrin glue & patch
Post-Op salvage
Micro sampling for labs
Minimize blood draw
Intra-Operative
Cell saver before Heparin, after Heparin heart lung machine - all blood to suckers
No discard sucker used
No lap sponges used
Minimize ray-tec use
Meticulous surgical technique
Minimize circuit priming volume
Minimize use of fluids on field
Use modified ultra-filtration
Surgeon and team must be directly involved in all decisions regarding acceptable hemoglobin level and need for transfusion
Bloodless Ross Operation
In 1998 the Miami Children’s team reported the first bloodless Ross Operation in a small child. This technically complex operation was achieved without the use of blood products through the application of our multidisciplinary effort.
Institutional Commitment
Miami Children’s Hospital administration totally supports the multidisciplinary team effort in Bloodless Surgery
Questions
Linda Rusinoswki Bloodless Cardiovascular Surgery Nurse Practitioner Coordinator contact info
We have worked with the Miami Liaison Committee for Jehovah’s Witnesses as part of our multidisciplinary effort. Committee members are available twenty four hours a day to support patients and families of the Jehovah's Witnesses faith.
Address: 3200 S.W. 60th Court, Suite 102, Miami, Florida 33155
Phone: (305) 663-8401 Fax: (305) 669-6574
E-mail: Jeff White
with questions or comments about this web site.
