Bucheon Sejong Hospital, Korea's only cardiac hospital designated by the Ministry of Health and Welfare, succeeded in advanced bloodless surgery using extracorporeal membrane oxygenation (ECMO) for a heart disease patient who wanted bloodless treatment for religious reasons.
Bloodless surgery is also being performed at other hospitals, but any case of successful heart failure treatment by maintaining ECMO without blood for more than two weeks has never been reported yet globally.
Park In-cheol (false name, male, 53 years old) is a patient suffering from chronic aortic regurgitation and heart failure. He had delayed surgery several times for religious reasons before visiting the hospital as he experienced worsening shortness of breath.
Director Yoo Jae-seok of the Thoracic Surgery Department at Bucheon Sejong Hospital, who performed the operation, said, "There were many things to consider. For example, we couldn't use warfarin, which prevents blood clotting because the patient wanted bloodless surgery for religious reasons. "Moreover, heart failure treatment using ECMO was highly likely after the surgery because the patient suffered aortic valvular regurgitation for a long time, leading to poor heart function and severe cardiac hypertrophy," he explained.
On January 26 (Tuesday), DR. Yoo completed aortic root replacement and aortic valve replacement, but the patient showed low cardiac output syndrome and pulmonary edema. On the third day of surgery, ECMO, a device that aids the heart by pumping the blood from the veins into the arteries, was inserted. The ECMO is a device that supports cardiopulmonary function from outside the body by supplying oxygen to the blood through the lungs and sending the oxygenated blood throughout the body as a pump of the heart does.
In general, blood transfusions are inevitable while using this device, as heparin needs to be used to prevent blood clotting and hemolysis occurs in which blood cells are destroyed gradually. A case of using the device for more than 2 weeks without blood has not been reported yet so far.
Suffering from serious conditions several times while using the ECMO treatment, he gradually got better and ECMO was removed on February 13 (Sat), the 18th day of surgery. After additional treatment, Park was moved to the general ward and gradually recovered. He was discharged on April 10 (Sat), the 74th day of surgery.
Lee Jong-hyun, head of the Bloodless Center (Director of Anesthesia and Pain Medicine) at Bucheon Sejong Hospital, said, “Bloodless surgery requires a high level of skill because it is difficult not only to correct anemia but also to arrest hemorrhage and use anticoagulants.” "Bucheon Sejong Hospital is actively performing bloodless surgery by applying effective techniques while reducing bleeding based on clinical experiences accumulated for a long time, and the prognosis of treatment is good," he said. “In a situation where blood is absolutely in short supply due to low birthrate, aging population, and covid-19, bloodless surgery or patient blood management techniques should be actively used in medicine," added he.
Director Yoo said, "Despite the fact that it took a long time to stabilize after the surgery, the patient endured the entire process well, and the bloodless surgery team did their best on follow-up care for the patient. I think all this was a recipe for a good result like this." He continued, "Active bloodless heart surgery and ECMO treatment are possible even for heart disease patients who reject blood transfusions due to religious reasons, especially for those with severe heart failure, and there are alternatives such as ventricular assist devices and heart transplants.”