First bloodless heart transplant on 6-year-old boy performed at Nationwide Children's Hospital

Jul 5 2011

Between injuries from severe storms that ripped across the country this spring, to the typical blood donation shortage seen each and every summer, experts say that the nation's blood supply is running low. At Nationwide Children's Hospital, doctors are helping to offset that demand by what's known as "bloodless" techniques.

In December 2010, Nationwide Children's performed its first bloodless heart transplant on a 6-year-old boy from New Jersey. On that day, Andrew Craver became one of the youngest patients known to have a successful bloodless heart transplant, and at one of only a few pediatric institutions that has the resources to perform it.

Mark Galantowicz, MD, FACS, chief of Cardiothoracic Surgery at Nationwide Children's, led the bloodless heart transplant on little Andrew, and said that it took an entire team dedicated to blood conservation before, during and after the surgery that made it successful. It was that team approach that helped Andrew get back to being an energetic kid.

"We not only conserve blood when a patient family makes the request, but we do so during all procedures and surgeries here at The Heart Center," said Dr. Galantowicz, co-director of The Heart Center at Nationwide Children's Hospital, and also a faculty member of The Ohio State University College of Medicine. "It takes an entire team - from pre-op nurses to anesthesiologists and perfusionists to post-op nurses - to achieve a successful bloodless outcome. It also takes a team with the experience of a systematic approach of always trying to achieve a bloodless outcome no matter the case."

The bloodless transplant was a religious preference for Andrew's father and mother, Ian and Rachel Craver, of North Cape May, New Jersey, with the philosopy behind it to avoid the need for blood transfusions.

"When the body is introduced to something foreign (e.g. a blood transfusion), it stimulates the immune system resulting in an inflammatory response," said Dr. Galantowicz. "With that inflammatory response, the body swells and there is risk for infection. To reduce that risk and swelling, a bloodless procedure is always the goal for my team no matter the case."

Some of the techniques employed by Dr. Galantowicz and his team include limiting how much blood they take for testing pre-operatively; using a machine known as a 'cell saver' during the procedure which captures shed blood, processes it and puts it right back into the body; and utilizing modified tubes and heart/lung bypass machines which have smaller components to reduce the neccessity of blood.

Andrew's case - a heart transplant - presented the ultimate challenge for the team in blood conservation as the body needs to react to an entirely new organ. And seven months later, Timothy Hoffman, MD, medical director of the Heart Transplant and Heart Failure Program at Nationwide Children's, couldn't be happier with Andrew's outcome.

"We (The Heart Center at Nationwide Children's Hospital) had been involved in Andrew's care since he was just 3-years-old," explained Dr. Hoffman, also with The Ohio State University College of Medicine. "He presented to us with a condition known as dilated cardiomyopathy in which the heart is weakened and enlarged. We managed Andrew with medications and close monitoring, however, eventually his heart failure worsened despite maximal outpatient therapy. It was then, the end of 2010, that Andrew was placed on the heart transplant waiting list. And, today, Andrew is back to being an active 6-year-old full of energy."

Studies have shown that using a patient's own blood cuts infection rates by more than half. Dr. Galantowicz says transfusions are still mostly safe and are needed in many cases, but he would like to see more surgeons try to treat patients with as few transfusions as possible.