patients (male and female) undergoing isolated coronary artery bypass grafting,

isolated aortic or mitral repair or replacement, and

combined aortic or mitral valve repair or replacement and

coronary bypass grafting

reoperation,

endocarditis,

dialysis dependant renal failure,

pre-operative ecmo or lvad support,

contraindication to blood transfusion (ie. jehovah's witness), and

use of irreversible anti-platelet (other than asa) and anticoagulant agents within 48h (ie. plavix, dabigitran, gpiib/iiia inhibitors, argatroban).