Cardiac surgery and cardiopulmonary bypass

Congenital heart defects are the most common birth defect, affecting approximately 1% of patients in the United States. Up to 20% of these patients require cardiac surgery within the first 30 days of life, and many may require multiple surgeries throughout their lifetimes. Bleeding during congenital cardiac surgery is associated with an increased incidence of postoperative morbidity and mortality, both from the direct effects of bleeding and the therapies employed to restore hemostasis. The coagulopathy associated with congenital heart disease (CHD) and cardiac surgery with cardiopulmonary bypass (CPB) is complex and multifactorial due to age-related hemostatic differences, pathophysiology of CHD, and the effects of CPB. In this chapter, we will review key alterations in hemostasis associated with CHD and CPB. We will also address preoperative optimization and blood conservation techniques, management of anticoagulation during CPB, and diagnosis/treatment of coagulopathy and bleeding in the perioperative period.