Perfusion
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Heparin-induced thrombocytopenia (HIT) is a serious, antibody-mediated complication of heparin which significantly confers risks of thrombosis and devastating outcomes. Once diagnosed, it requires immediate cessation of heparin and therapy with an alternative anticoagulant. No data are available in the literature on the pathophysiology and clinical implications of performing prolonged extracorporeal membrane oxygenation with a heparin-coated system in a patient with acute HIT treated with bivalirudin.
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The purpose of this descriptive study was to examine the relationship between heparin levels (HL) determined by heparin protamine titration (HPT) and activated clotting time (ACT) for cardiopulmonary bypass (CPB) in an adult cardiac surgery population. We examined institutional databases for all patients who underwent CPB at a single US academic institution from February 2005 until July 2007. Baseline ACT, predicted and actual heparin dose response (HDR), target and actual ACT, heparin concentration and heparin bolus dose were recorded. ⋯ The Post-Hep and CPB+10 ACT and HL are reported for 3802 patients. The distribution of ACTs for HL of 0.7, 1.4, 2.0, 2.7 and 3.4 units heparin/mL blood at both time points are reported. Additional analysis of the relationship of HL to ACTs of 300, 350, 400 and 480 seconds is also presented.
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Randomized Controlled Trial Comparative Study
Propofol requirement titrated to bispectral index: a comparison between hypothermic and normothermic cardiopulmonary bypass.
Though propofol requirement is expected to decrease during cardiopulmonary bypass (CPB), a few studies have failed to demonstrate this. The factors affecting pharmacokinetics of propofol and, therefore, the requirement, are different during hypothermic and normothermic CPB. We evaluated and compared the requirement of propofol during hypothermic and normothermic CPB. ⋯ The BIS (median +/- inter quartile range) remained constant during normothermic CPB (50 +/- 8.8), but declined significantly during hypothermic CPB (41 +/- 5.6) despite decreased usage of propofol during hypothermia. No patient had recall of intra-operative events. CPB decreases the magnitude of propofol requirements and the effect of hypothermic CPB is significantly more than that of normothermic CPB.
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Randomized Controlled Trial
Beneficial effects of modern perfusion concepts in aortic valve and aortic root surgery.
Minimized perfusion circuits (MPC) were found to reduce side effects of standard extracorporeal circulation (ECC). We evaluated the safety and efficacy of the ROCsafe MPC for aortic valve and aortic root surgery. One hundred and seventy patients were randomized for surgery using either MPC [n = 85, 30 female/55 male, mean age: 69.8 +/- 11.8 years; aortic valve replacement (AVR): n = 40; AVR + coronary artery bypass graft (CABG): n = 31; David operation: n = 3; aortic root replacement (ARR): n = 11] or ECC [n = 85, 29 female/56 male, mean age: 67.7 +/- 9.5 years; AVR: n = 39; AVR+CABG: n = 35, David operation: n = 2; ARR: n = 9]. ⋯ One stroke occurred in each group. The ROCsafe MPC provides safe circulatory support for a wide range of aortic valve surgeries. Transfusion requirements, postoperative bleeding and length of ICU stay were markedly reduced compared to standard extracorporeal perfusion.