• Total perioperative blood loss [ Time Frame: During surgery ] [ Designated as safety issue: Yes ]
  

• Components of the hemostatic profile will be compared between groups as secondary outcome variables [ Time Frame: 24 hours ] [ Designated as safety issue: Yes ]
  

The primary hypothesis of this study is that in our study population, compared to re-infusion of residual CPB blood, re-infusion of only the red cell component of residual CPB blood, causes a lesser defect in clotting, leading to decreased hemorrhage and less post-operative blood loss.

The secondary objectives of this project are to document the effects on the clotting system of pump blood re-infusion by means of in laboratory testing. This work has not been done and is of crucial importance to future optimization of the use of pump blood. We expect to detect and quantify with significant accuracy any increased bleeding risk with our hemostatic profiling. This information will be invaluable in planning the safe introduction of residual CPB blood re-infusion smaller children and those with increase risk of postoperative blood loss. Furthermore, we will determine whether or not any of the potentially beneficial effects to the clotting system of returning all components of residual CPB blood, such as an increase in functioning platelets, or an increase in clotting factors, are realized. This information will determine the utility of pursuing means by which these non red cell components of residual CPB blood can be safely re-infused.

Induction of anesthesia, arterial and venous vascular catheter placement, heparin administration, cardiopulmonary bypass machine setup and priming, conduct of CPB, ultrafiltration of blood during CPB, post-CPB protamine administration and post-CPB blood ultrafiltration will all be standardized as per current clinical practice.

Residual CPB blood will be processed and re-infused according to group allocation.

Intravascular volume in the form of crystalloid, and blood products will be administered over and above the study residual blood product infusion as required according to protocol.

Subjects will have blood sampled for hemoglobin concentration immediately after induction of anesthesia and again 24 hours following their surgery.

Arterial blood will be sampled from the patient for a hemostatic profile, outlined in the adjacent text box, after separation from CPB and prior to initiation of residual CPB blood product re-infusion. A second sample will be obtained when re-infusion of residual CPB blood product is complete. In addition, a hemostatic profile will be run directly on a sample of the residual CPB blood product.

Subject demographic data, surgical diagnosis and procedures, CPB data, all medication, blood product and intravenous fluid administration, total volume of study fluid administered, blood lost during surgery to sponges and suction and 24 hour mediastinal drainage will be recorded for all subjects. Any cases of incomplete re-infusion of study blood product will be noted as will the reason for the occurrence.