How bloodless open heart surgeries are performed

500,000 open heart surgeries are performed in the U.S. every year, and half of those patients require a blood transfusion. But what if you’ve had a complication during a transfusion in the past, or your religion forbids blood transfusions?

It is a major, life-saving procedure, but it can also cause significant blood loss. Open heart surgery presents special challenges for patients who must avoid blood transfusions. Dr. John Puskas, a cardiovascular surgeon at Mount Sinai in New York, says one key is to prepare well before the patient is wheeled into the operating room.

“We give patients something called erythropoietin, a hormone that increases their blood counts prior to surgery,” Puskas said.

For bypass patients, Puskas and his colleagues can use a new surgical technique.

“We do this all-arterial, no-aortic-touch operation, meaning we don’t connect any of the bypass grafts to the aorta,” Puskas said.

By avoiding the aorta, doctors minimize blood loss. The no-touch bypass surgery means they can also avoid putting a patient on a heart-lung machine, which lowers the risk of blood loss. And if patients do lose blood, doctors use a medical procedure to safely recycle it.

“We use these cell savers or cell salvage devices in the operating room,” Puskas said.

These medical techniques save lives and allow doctors to respect patients’ wishes. There are now around 100 hospitals in the U.S. with specialized programs that can accommodate bloodless or transfusion-free surgeries.

Practicing Jehovah’s Witnesses and Christian Scientists have religious beliefs that require them to avoid transfusions. Others have conditions that cause allergic reactions to the transfused blood.