The heart surgery forum
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The heart surgery forum · Jan 2005
Case ReportsClopidogrel-related refractory bleeding after coronary artery bypass graft surgery: a rationale for the use of coagulation factor concentrates?
Clopidogrel, an irreversible ADP-receptor antagonist, inhibits platelet aggregation mediated by reduced activation of glycoprotein receptor IIb/IIIa. Clopidogrel in combination with aspirin has been shown to be superior to aspirin alone for treating unstable angina, but clopidogrel recipients have shown increases in blood loss, transfusion requirements, and rate of reoperation after cardiac surgery. We describe a patient who had taken clopidogrel 75 mg daily until the day prior to coronary artery bypass graft surgery. ⋯ Then, to promote clot formation and firmness, 2 g of fibrinogen and 1250 IU of factor XIII were administered, and the bleeding finally stopped. No further transfusions were required, and the patient was discharged from the hospital on day 10 after the operation. This case suggests that in clopidogrel-related bleeding refractory to conventional hemostatic therapy, hemostasis may be achieved by a stepwise administration of coagulation factor concentrates.
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The heart surgery forum · Jan 2005
Case ReportsImpending paradoxical embolism across a patent foramen ovale: case report.
We describe a case of impending paradoxical embolism in a 43-year-old male patient with pulmonary embolism. Transesophageal echocardiography revealed a thromboembolus straddling a patent foramen ovale. ⋯ A postoperative work-up for a hypercoagulable state revealed a protein-S deficiency and bilateral lower extremity deep vein thromboses. A Greenfield inferior vena cava filter was inserted, anticoagulation was performed, and warfarin treatment was continued after the patient was discharged home.
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The heart surgery forum · Jan 2005
Outcomes for off-pump coronary artery bypass grafting in high-risk groups: a historical perspective.
The outcomes of off-pump coronary artery bypass (OPCAB) and conventional coronary artery bypass grafting with cardiopulmonary bypass (cCABG) have been compared in detail. Similarly, several reports have examined outcomes of high-risk subsets of patients in OPCAB as a selection strategy for reducing morbidity and mortality compared to cCABG. We undertook a retrospective study comparing outcomes from the early years in our experience of beating-heart surgery in high-risk patients selected for OPCAB compared to low-risk patients having OPCAB. This study was premised on strict selection criteria in an era prior to stabilizing devices and cardiac positioners. ⋯ In this retrospective and historical review, OPCAB was found to be equally safe in carefully selected high- and low-risk patients. These results provided for the enthusiasm and innovation to expand the usage of OPCAB in patients with coronary artery disease.
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The heart surgery forum · Jan 2005
Time and risk analysis for acute type A aortic dissection surgery performed by hypothermic circulatory arrest, cerebral perfusion, and open distal aortic anastomosis.
Hypothermic total circulatory arrest, retrograde or antegrade cerebral perfusion, and open distal anastomosis are important stages of surgical management and cerebral protection for acute type A dissections. Among the factors that influence survival are the transfer time to hospital from the onset of symptoms, in-hospital transfer time to operation, organ malperfusion, preoperative risk factors, and intraoperative variables. The aim of this study was to analyze time and risk factors during surgical management. ⋯ Total circulatory arrest, cerebral perfusion, and open distal anastomosis are reliable options in the surgical management of acute type A aortic dissections. With open distal anastomosis aortic arcus can be evaluated, distal anastomosis can be performed more easily, and postoperative neurological recovery is hastened. In the present study, although statistical significance could not be reached due to limited sample size, the time to admission, durations of total circulatory arrest, cross-clamp, and cardiopulmonary bypass, and the amount of postoperative chest output seem to influence postoperative survival.
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The heart surgery forum · Jan 2005
Myocardial protection using HTK solution in minimally invasive mitral valve surgery.
Minimally invasive cardiac surgery (MICS) is a safe and satisfactory approach used mainly in mitral valve surgery with excellent results in many centers. Cardioplegia administration can be still a problem, especially when an endoaortic clamp is used. We retrospectively analyzed our early results with histidine-triptophane-ketoglutarate (HTK) solution used for myocardial protection in MICS. ⋯ HTK solution is a cold crystalloid cardioplegia solution that has demonstrated its utility in MICS because it provides a safe long cardioplegic arrest time and it reduces the risk of inadequate coronary perfusion due to dislodgement of the endoaortic clamp.