Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Jun 2009
Suction, salvage, sutures, and potions: blood management post-aprotinin.
Hemostasis management of the cardiac surgical patient has changed following the withdrawal of aprotinin for use in cardiac surgical patients. The challenge to minimize blood loss and reduce exposure of cardiac surgical patients to blood products continues to grow with patients presenting being older and sicker and more complex procedures being performed. The cardiac surgery team has many options available for it to consider; although current recommendations strongly support the use of cell salvage as one process to assist in this challenge, other options need to be equally critically evaluated.
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Semin Cardiothorac Vasc Anesth · Jun 2009
Endovascular treatment of blunt traumatic thoracic aortic injury.
Blunt traumatic thoracic aortic injury (BTTAI) is a lethal injury associated with a prehospital mortality of 80% to 90%. Patients arriving in the emergency room and considered appropriate to undergo emergency open surgical repair still have a mortality rate of 15% to 30% because of severe associated injuries. Conventional open surgical repair requires a left thoracotomy, single lung ventilation, aortic-cross clamping and unclamping, with or without the adjunct use of partial or full cardiopulmonary bypass and systemic heparinization. ⋯ Endovascular repair of BTTAI does not require a thoracotomy, single lung ventilation, aorticcross clamping and unclamping, or systemic heparinization. As a result, endovascular repair of BTTAI has emerged as an effective, minimally invasive treatment alternative, especially in patients with severe concomitant injuries, which may be prohibitive to open surgical repair. Recent published studies have shown that endovascular repair of BTTAI is associated with lower morbidity, mortality, stroke, and paraplegia/paraparesis rates, when compared with open surgical repair of BTTAI.