Bloodless Medicine and Cardiac Surgery
An Interview with Giovanni Speziali, MD
Giovanni Speziali, MD, has been on the staff of UPMC since 2006 and is the chief of Cardiac Surgery at UPMC Passavant
. Prior to UPMC, Dr. Speziali spent 11 years at the Mayo Clinic.
Please describe your approach to controlling bleeding and reducing transfusion requirements in cardiac surgery.
I consider decreasing transfusion requirements to be a noble objective for any cardiac surgery, as reducing the usage of blood products has been shown to correlate with better patient outcomes.
I was trained in neonatal cardiac surgery, where blood conservation is obviously of the highest importance.
In doing these surgeries I developed the practice of giving greatest attention to promptly arresting all bleeding, not just at the end of a surgery, but during all phases of a surgery.
My partner, Chris Cook, MD, and I have continued this meticulous approach with all of our surgeries, which in our current practice are performed upon adult patients.
Are there steps that you are able to take prior to surgery to decrease transfusions?
Yes. We carefully assess the medications that a patient may be taking to identify those that may cause more surgical bleeding.
This includes both pharmaceutical products as well as herbal products that a patient may be taking.
We counsel our patients to discontinue any medications that will increase their bleeding.
We also consider whether products such as iron and recombinant erythropoietin may be advisable for a particular patient to increase his blood production preoperatively.
Are there other methods that you use to reduce transfusion requirements?
Yes. We use cell salvage machines that clean and recycle shed blood back to the patient. This can significantly reduce the amount of blood lost.
Additionally, we have found that by the use of state-of-the-art technology in our cardiopulmonary bypass circuits, we are able to reduce the size of these circuits and reduce the amount of nonblood fluids administered to the patient.
These smaller cardiopulmonary bypass circuits result in lower reliance upon transfusions in cardiac surgery.
Have your efforts at blood conservation yielded results?
Our patients benefit when there is a dramatic reduction in the use of blood products during heart surgery.
We are currently working with an initiative at UPMC Passavant to examine how transfusions for all patients can be reduced through the use of cutting-edge technology, a collaborative approach, and close adherence to evidence based transfusion practice.
Our efforts in blood conservation have given us the confidence to provide advanced treatment to patients who require the avoidance of blood and blood product transfusions.
Over the years, we have been pleased to provide care to many such patients. The Center for Bloodless Medicine and Surgery at UPMC has provided us with yet another asset in being able to carefully assess the needs of such patients, so we may deliver care in a way that accords respect for patients’ preferences for nonblood medical management.
Dr. Cook and I routinely accept and operate on patients who refuse transfusions, such as Jehovah’s Witnesses.
How can patients arrange a consultation?
Call 412-369-4603 and inform the office staff that you are interested in being evaluated for bloodless surgery.