Newborn first in Western U.S. to have ‘bloodless’ open-heart surgery

[Guest Nicole]

Lola Garcia of Hemet, California, was the smallest infant in North America to undergo such a procedure.

Physicians at Lucile Packard ChildrenÂ’s Hospital Stanford have performed open-heart surgery without a blood transfusion on the smallest infant ever to undergo such a procedure in North America.

The surgery was done on a 10-day-old baby girl born in Hemet, California, with a serious congenital heart defect. Meticulous planning and execution of the surgery, an arterial switch procedure, allowed the medical team to surmount daunting technical challenges of treating a 7-pound open-heart patient without giving her a blood transfusion. It is the first “bloodless” open-heart surgery performed on an infant in the Western United States.

“If you can do surgery safely and effectively without transfusion, there are several medical benefits,” said Frank Hanley, MD, chief of pediatric cardiac surgery at the hospital’s Betty Irene Moore Children’s Heart Center and one of two surgeons who performed the procedure. He said patients who do not receive blood products have fewer post-surgical complications, provided they do not lose too much blood.

“You have to be able to do the surgery safely and not have the patient’s red blood cell count drop too low,” added Hanley, who is he Lawrence Crowley, MD, Professor in Child Health at the Stanford School of Medicine.

A severe heart defect

From the moment of her birth on Oct. 21, little Lola Garcia struggled to breathe. She and her parents, Felisa and Jared Garcia, were rushed to a childrenÂ’s hospital near the familyÂ’s home.

Lola was diagnosed with transposition of the great arteries, a rare condition in which the heart’s major arteries are not connected correctly. Normally, the blood follows a single, figure-eight-shaped circuit through the heart and lungs, then back to the heart and out to the body to supply oxygen to organs. In Lola’s heart, the blood made two separate circuits — from the heart to the lungs and back, and from the heart to the body and back. The normal figure-eight was separated into two poorly connected loops. Her brain and other organs were not getting enough oxygen.

“They said she would definitely need heart surgery, and most likely a blood transfusion, to correct the problem,” said Felisa. “We were happy there was a solution, but when they said ‘transfusion,’ my heart dropped.” The Garcias are Jehovah’s Witnesses; they requested that Lola’s surgery be done without a blood transfusion because of their religious beliefs.

Although many hospitals now offer bloodless surgery for adults, the challenges of avoiding transfusion are much greater in newborns who need open-heart procedures. Several hospitals around the country turned the family down. But the pediatric cardiothoracic surgery team at Packard ChildrenÂ’s offered to attempt baby LolaÂ’s arterial switch procedure without transfusing blood.

“Very few people have the technical expertise to do this,” said Vamsi Yarlagadda, MD, a clinical associate professor of pediatrics at the School of Medicine and the cardiologist at Packard Children’s who cared for Lola.

Technical hurdles

During surgery, Lola needed to be connected to a heart-lung machine, which would pump her blood through a circuit of tubing and membranes for re-oxygenation.

The machineÂ’s tubing is primed with saline that mixes with the patientÂ’s blood. For an adult, the volume of saline in a standard heart-lung machine does not dilute the blood enough to be dangerous, but a 7-pound newborn has less blood to begin with. Connecting Lola to a standard heart-lung circuit would have dangerously lowered her red blood cell count.

In the past, the problem has been solved by transfusing blood. For Lola, the Packard ChildrenÂ’s team took a different approach.

Read more: http://med.stanford.edu/news/all-news/2018/02/newborn-first-in-western-us-to-have-bloodless-open-heart-surgery.html