Perfusion
-
Extracorporeal lung assist (ECLA) is an established treatment of severe pulmonary failure. Since extracorporeal perfusion is applied in a long-term fashion in this setting, the negative impact on blood compounds is of tremendous importance. Pumpless arteriovenous ECLA (av-ECLA) is an alternatively introduced technique that focuses on reduced blood traumatization. ⋯ Accordingly, reasonable indications for its beneficial use are discussed. It is concluded that av-ECLA is a feasible technique when its limitations are accepted. For adequate clinical use, more data concerning indications, as well as time- and technique-related directions are required.
-
There have been several new cardioplegia delivery systems that have been developed by various manufacturers in the last few years. In this evaluation, the safety and costs associated with the present 4:1 roller pump cardioplegia delivery were compared to the Medtronic Cardioplegia Safety System (CSS). One hundred and five patients participated in a randomized, prospective evaluation. ⋯ There was a reduction of 35% in the use of a hemoconcentrator in group B, with more total cardioplegia delivered. The cardioplegia patient cost savings in group B totaled $265.95 per case in the plain cardioplegia group and $315.95 with the amino acid cardioplegia group. The new technology incorporated into the Medtronic CSS demonstrated that it could provide more safety with less cost than the current cardioplegia pump system.
-
Comparative Study
Whole blood heparin concentrations do not correlate with plasma antifactor Xa heparin concentrations in pediatric patients undergoing cardiopulmonary bypass.
This study was designed to test the validity of whole blood heparin concentration (WHBC) measurements using an on-site protamine titration assay with the Hepcon instrument (Medtronic Blood Management, Parker, CO, USA) in pediatric patients less than 1 year old undergoing cardiopulmonary bypass (CPB). The validity of the Hepcon measurements was examined via a test of correlation with the gold standard plasma antifactor Xa activity (anti-Xa) assay. Fifty-one patients (23 females and 28 males) under 1 year old (mean age 5.3 months) were studied prospectively. ⋯ While a nonparametric statistical analysis revealed that the mean corrected values from the Hepcon instrument were not significantly different from the mean anti-Xa values (p = 0.070 at 5 min on CPB, p = 0.518 at the end of CPB), there was no significant correlation between these values at either 5 min into CPB (r = 0.113, p = 0.429) or at the end of CPB (r = -0.247, p = 0.080). The lack of correlation between the two assays may be related to the extreme hemodilution observed during CPB in small children, which leads to very low concentrations of coagulation proteins. Due to this discrepancy, whole blood heparin monitors should be further evaluated in children undergoing CPB.
-
Case Reports
Redo cardiac surgery in a Jehovah's Witness, the importance of a multidisciplinary approach to blood conservation.
Although Jehovah's Witnesses present a particular problem when undergoing surgery because of their refusal to accept stored blood, it is now quite common to undertake uncomplicated cardiac surgery in these patients. Complex or redo cardiac surgery however, is often associated with major blood loss, and is conventionally contraindicated in Jehovah's Witnesses. We describe the perioperative management of a Jehovah's Witness who underwent a resternotomy for mitral valve replacement and coronary artery bypass grafting having previously had an aortic valve replacement and mitral valve repair. The importance of a multidisciplinary approach to blood conservation is discussed.