 Previous sternotomy Emergency surgery Combined procedures vascular or thoracic operations Congenital repair Hypothermic CPB 28C Serum creatinine 1.5 mgdL Dialysis dependent renal failure Neurologic injury or event within 30 days including TIA Cerebrovascular accident with significant residual neurologic deficit Severe COPD with FEV1 45 of predicted Home oxygen use Previous difficult intubation Acute normovolemic blood conservation techniques Liver disease with serum AST 31 UL Circulatory arrest Thrombolysis Pre-existing clotting disorder Platelet receptor GPIIbIIIa antagonist medication received within 48 hours Steroids EF 40 Intra-aortic balloon pumps Ongoing congestive heart failure Ventricular assist devices Total hearts Pregnant women Adults lacking capacity to consent Any patients initially enrolled in the study that end up with an intra-aortic balloon pump, left ventricular assist device, or on extracorporeal membrane oxygenation will be eliminated from the study. 