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Clinical Briefing: Transfusion-Free Heart Surgery

March/April 2007

The University of Pennsylvania Health System's Pennsylvania Hospital is a national leader in bloodless surgery. The bloodless cardiac surgery team includes cardiac surgeons, hematologists, cardiologists, anesthesiologists and perfusionists facile in blood conservation techniques and blood-sparing technologies. Historically, this specialized therapy was reserved for those who refused blood transfusions for religious reasons. Today, transfusion-free heart surgery is offered to all patients who meet certain criteria.

“Heart surgery is associated with the greatest blood loss of all surgical procedures so it is a technical challenge to routinely perform open heart surgery without a transfusion. We have the infrastructure in place to perform these bloodless surgeries often and well,” says Charles R. Bridges, Jr., MD, ScD, Chief, Cardiothoracic Surgery, Pennsylvania Hospital.

Case Study
Mr S., an active, sixty year-old man, was referred to the Penn Cardiac Care surgical team at Pennsylvania Hospital by his cardiologist because of worsening fatigue with an amplified murmur. On presentation, an echocardiogram revealed significant mitral valve regurgitation. Dr. Bridges recommended minimally invasive surgery to correct the valve defect.

Mr. S. recognized his need for surgery but expressed concern for potentially requiring a blood transfusion. He thought storing his own blood for transfusion was his only “safe” option. Dr. Bridges explained that his minimally invasive surgical technique combined with a bloodless medicine approach were the best options for avoiding transfusion of any type.

Dr. Bridges referred him to Patricia Ford, MD, Medical Director of the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital. Preoperative assessment revealed Mr. S. was a good candidate for bloodless cardiac surgery. The team developed a plan that included pre-surgical dietary and pharmacotherapy strategies, intra-operative use of a mini-circuit heart-lung machine and minimally invasive techniques, and post-operative nutritional support, pharmacotherapy and limited phlebotomy.

Mr. S. successfully underwent minimally invasive, transfusion-free mitral valve repair. The procedure was performed through a small incision under the breast allowing for an excellent cosmetic result, less pain and blood loss, and faster recovery. He returned to home three days after his surgery and is now back to his pre-illness state of health.

Our Team of Faculty
Given the complexity of performing bloodless and transfusion-free cardiac surgery, The Center for Bloodless Medicine and Surgery at Pennsylvania Hospital uses a multidisciplinary approach, combining the expertise of Penn specialists in anesthesia, cardiology, cardiac surgery and hematology. Our team also includes the region's finest bloodless care coordinators, nurses, pastoral care staff, perfusionists and social workers. Our goal is to partner with you, the referring physician, in meeting the unique physical and emotional needs of your patients. Please do not hesitate to contact us for consultation or referral.

Charles R. Bridges Jr., MD, ScD
Chief, Cardiothoracic Surgery, Pennsylvania Hospital

Patricia C. Ford, MD
Medical Director, Center for Bloodless Medicine and Surgery, Pennsylvania Hospital

Gina Keck, BSN, OCN
Clinical Program Coordinator

B. Reddy Dandolu, MD
Cardiovascular Surgeon

Jonathan Parmet, MD
Director, Cardiac Anesthesia

Charles Yarnall, BS
Chief Perfusionist

Clinical Surgical Specialists and Practitioners

Diane Angelos, RN, MSN
Cardiology Coordinator

Bryan Blanchard, MSN, CRNP

Alice Isidro, MS PA-C

Lizabeth Piel, MSN, CRNP

Jenni Rhodes, MS PA-C

Michael J. Columbus
Administrative Director, Center for Bloodless Medicine and Surgery, Pennsylvania Hospital

Carol Miller
Social Worker

David Brewington, Sr.
Lead Coordinator

Donna Maldonado-Schullo
Coordinator

Joseph Riddick, Jr.
Coordinator

William Walker
Coordinator

Access
Patient appointments are available at

Pennsylvania Hospital
230 W. Washington Square
Farm Journal Building, 3rd Floor
Philadelphia, PA 19106

Pennsylvania Hospital
Center for Bloodless Medicine
700 Spruce Street, Suite 102
Philadelphia, PA 19106

To refer a patient and/or consult with a doctor:

• Call PENNHealth: 1-800-789-PENN, or
• Visit Penn Cardiac Care

	Referring Physicians: To speak with a Penn physician or refer a patient, contact PennHealth through the secure online referral form or by calling 1-800-789-PENN (7366).