Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2016
Comparative StudyComparison of Two Different Red Blood Cell Transfusion Thresholds on Short-Term Clinical Outcomes of Patients Undergoing Aortic Surgery with Deep Hypothermic Circulatory Arrest.
Patients undergoing aortic surgery with deep hypothermic circulatory arrest (DHCA) usually are associated with a high rate of allogeneic blood transfusion, and their red blood cell (RBC) transfusion threshold is unclear and controversial. The purpose of this study was to explore whether a restrictive transfusion threshold was as effective as a liberal transfusion threshold for patients undergoing aortic surgery with DHCA. ⋯ For patients undergoing aortic surgery with DHCA, a restrictive RBC transfusion threshold (Hb<8 g per deciliter) may be as effective as a liberal RBC transfusion threshold (Hb<10 g per deciliter) during the surgery, with similar short-term clinical outcomes and less allogeneic transfusion.
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J. Cardiothorac. Vasc. Anesth. · Oct 2016
Observational StudyNoninvasively Measured Hemoglobin Concentration Reflects Arterial Hemoglobin Concentration Before but Not After Cardiopulmonary Bypass in Patients Undergoing Coronary Artery or Valve Surgery.
This study compared noninvasively measured hemoglobin and arterial hemoglobin before and after cardiopulmonary bypass in patients undergoing coronary artery or valve surgery. ⋯ The results suggested that noninvasive measurement of hemoglobin overestimates arterial hemoglobin by almost 1 g/dL when compared to iSTAT. A lack of precision also was observed with noninvasive measurement of hemoglobin, especially after cardiopulmonary bypass. These findings supported the contention that sole reliance on noninvasive measurement of hemoglobin for transfusion decisions in cardiac surgery patients may be inappropriate.
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J. Cardiothorac. Vasc. Anesth. · Oct 2016
An Adjusted Calculation Model of Reduced Heparin Doses in Cardiopulmonary Bypass Surgery in a Chinese Population.
To investigate the safety and efficacy of an adjusted regimen of heparin infusion in cardiopulmonary bypass (CPB) surgery in a Chinese population. ⋯ Adjusted regimen of heparin infusion could be used safely and effectively in Chinese CPB patients, which might reduce the initial and total dosage of heparin and protamine as well as sternal closure time and intraoperative blood transfusion volume.
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J. Cardiothorac. Vasc. Anesth. · Oct 2016
Heparin Reversal After Cardiopulmonary Bypass: Are Point-of-Care Coagulation Tests Interchangeable?
Protamine is used to neutralize heparin after patient separation from cardiopulmonary bypass (CPB). Different bedside tests are used to monitor the adequacy of heparin neutralization. For this study, the interchangeability of the activated coagulation time (ACT) and thromboelastometry (ROTEM; Tem Innovations GmbH, Basel, Switzerland) clotting time (CT) ratios in children undergoing cardiac surgery was assessed. ⋯ ACT, with or without heparinase, and the INTEM/HEPTEM CT ratios are not interchangeable to evaluate heparin reversal after pediatric patient separation from CPB. Therefore, the results of these tests should be corroborated with the absence/presence of bleeding and integrated into center-specific treatment algorithms.
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J. Cardiothorac. Vasc. Anesth. · Oct 2016
Surgical Repair of Mitral Valve Disease in Children: Perioperative Changes in Respiratory Function.
To assess the profile of changes in airway and respiratory tissue mechanics within a follow-up study performed in children with mitral valve disease, before and after surgical valve repair. ⋯ Mitral valve disease in children leads to abnormal airway and respiratory tissue mechanics. Even though surgical repair of mitral insufficiency alleviates abnormal airway function, residual lung tissue stiffening may persist even weeks after the surgery, contributing to a sustained impairment in lung function.