Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center

2004 ◽  
Vol 77 (2) ◽  
pp. 626-634 ◽  
Author(s):  
David M. Moskowitz ◽  
James J. Klein ◽  
Aryeh Shander ◽  
Katherine M. Cousineau ◽  
Richard S. Goldweit ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Cardiac Surgical Procedures ◽  
Blood Conservation ◽  
Transfusion Requirements

scholarly journals Thrombelastometry guided blood-component therapy after cardiac surgery: a randomized study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Martin Haensig ◽  
Joerg Kempfert ◽  
Pia-Maria Kempfert ◽  
Evaldas Girdauskas ◽  
Michael Andrew Borger ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Point Of Care ◽  
Postoperative Bleeding ◽  
Treatment Algorithm ◽  
Cardiac Surgical Procedures ◽  
Blood Component ◽  
Transfusion Requirements ◽  
Increased Risk ◽  
Significant Difference ◽  
Blood Component Therapy

Abstract Background Significant bleeding is a well known complication after cardiac surgical procedures and is associated with worse outcome. Thrombelastometry (ROTEM®) allows point-of-care testing of the coagulation status but only limited data is available yet. The aim was to evaluate the ROTEM®-guided blood component therapy in a randomized trial. Methods In case of significant postoperative bleeding (> 200 ml/h) following elective isolated or combined cardiac surgical procedures (including 14% re-do procedures and 4% requiring circulatory arrest) patients were randomized to either a 4-chamber ROTEM®-guided blood-component transfusion protocol or received treatment guided by an algorithm based on standard coagulation testing (control). One hundred four patients (mean age: 67.2 ± 10.4 years, mean log. EuroSCORE 7.0 ± 8.8%) met the inclusion criteria. Mean CPB-time was 112.1 ± 55.1 min., mean cross-clamp time 72.5 ± 39.9 min. Results Baseline demographics were comparable in both groups. Overall there was no significant difference in transfusion requirements regarding red blood cells, platelets, plasma, fibrinogen or pooled factors and the re-thoracotomy rate was comparable (ROTEM®: 29% vs. control: 25%). However, there was a trend towards less 24-h drainage loss visible in the ROTEM®-group (ROTEM®: 1599.1 ± 834.3 ml vs. control: 1867.4 ± 827.4 ml; p = 0.066). In the subgroup of patients with long CPB-times (> 115 min.; n = 55) known to exhibit an increased risk for diffuse coagulopathy ROTEM®-guided treatment resulted in a significantly lower 24-h drainage loss (ROTEM®: 1538.2 ± 806.4 ml vs. control: 2056.8 ± 974.5 ml; p = 0.032) and reduced 5-year mortality (ROTEM®: 0% vs. control: 15%; p = 0.03). Conclusion In case of postoperative bleeding following cardiac surgical procedures a treatment algorithm based on “point-of-care” 4-chamber ROTEM® seems to be at least as effective as standard therapy. In patients with long CPB-times ROTEM®-guided treatment may result in less bleeding, a marked reduction in costs and long-term mortality. Trial registration German Clinical Trials Register, TRN: DRKS00017367, date of registration: 05.06.2019, ‘retrospectively registered’.

The Use of an Absorbable Microporous Polysaccharide Hemosphere Haemostat (AristaAH®) in Ventricular Assist Device Implant and Cardiac Transplantation Procedures

2012 ◽  
Vol 8 (2) ◽  
pp. 125
Author(s):  
Brian A Bruckner ◽  
Matthias Loebe ◽  
◽  
Keyword(s):  
Surgical Procedures ◽  
Ventricular Assist Device ◽  
Cardiac Transplantation ◽  
Cardiac Surgical Procedures ◽  
High Risk Group ◽  
Cardiac Transplant ◽  
Assist Device ◽  
Ventricular Assist ◽  
Refractory Heart Failure ◽  
Haemostatic Agents

Topical haemostatic agents are useful adjuncts for the overall approach to haemostasis during mechanical support and cardiac transplant surgical procedures. Increasing numbers of cardiac surgical patients are presenting with pharmacologically induced impairment of the clotting cascade. Additionally, there continues to be an increase in the numbers of ventricular assist device implantations worldwide and these patients have haemostasis challenges both at the time of implantation and at subsequent transplantation. Patients undergoing assist device placement or cardiac transplantation usually have severe, refractory heart failure and varying degrees of multi-organ dysfunction, which make them susceptible to bleeding during the surgical procedure. Despite routine blood conservation measures and the use of intravenous agents, local surgical field haemostasis still remains a challenge. Topical agents are increasingly used in cardiac surgical procedures, especially in assist device or transplant cases. Herein, we report our institutional approach to topical haemostasis in a high-risk group of patients undergoing assist device or cardiac transplant. AristaAH®, a novel polysaccharide topical haemostat, provides effective and safe control of challenging bleeding situations.

Microporous Polysaccharide Hemosphere Absorbable Hemostat (AristaAH®) in Re-Operative Cardiac Surgical Procedures

2012 ◽  
Vol 9 (2) ◽  
pp. 96-98
Author(s):  
Brian A Bruckner ◽  
Matthias Loebe
Keyword(s):  
Patient Outcomes ◽  
Surgical Procedures ◽  
Systematic Approach ◽  
Surgical Intervention ◽  
Transfusion Requirement ◽  
Cardiac Surgical Procedures ◽  
Platelet Inhibitors ◽  
Hemostatic Agents ◽  
Surgical Field ◽  
Improve Patient

Patients undergoing re-operative cardiac surgical procedures present a great challenge with regard to obtaining hemostasis in the surgical field. Adhesions are ever-present and these patients are often on oral anti-coagulants and platelet inhibitors. As part of a well-planned surgical intervention, a systematic approach to hemostasis should be employed to decrease blood transfusion requirement and improve patient outcomes. Topical hemostatic agents can be a great help to the surgeon in achieving surgical field hemostasis and are increasingly being employed. Our approach, to these difficult patients, includes the systematic and planned use of AristaAH, which is a novel hemostatic agent whose use has proven safe and efficacious in our patient population.

Outcomes of cardiac surgical procedures performed by trainees versus consultants: a systematic review with meta-analysis

2021 ◽  
Author(s):  
Antonio C. Escorel Neto ◽  
Michel Pompeu Sá ◽  
Jef Van den Eynde ◽  
Hajar Rotbi ◽  
Chi Chi Do-Nguyen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Procedures ◽  
Meta Analysis ◽  
Cardiac Surgical Procedures

Rhythm control: surgical ablation

ESC CardioMed ◽  
2018 ◽  
pp. 2173-2177
Author(s):  
Chawannuch Ruaengsri ◽  
Matthew R. Schill ◽  
Richard B. Schuessler ◽  
Ralph J. Damiano
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Treatment Option ◽  
Surgical Procedures ◽  
Antiarrhythmic Drugs ◽  
Cardiac Surgical Procedures ◽  
Rhythm Control ◽  
Maze Procedure ◽  
Hybrid Procedures ◽  
Surgical Ablation

Surgical ablation for atrial fibrillation was introduced in 1987 and has since become well established as a treatment option for patients with symptomatic atrial fibrillation refractory to antiarrhythmic drugs and/or catheter ablation or patients who are having concomitant cardiac surgical procedures. The Cox–Maze procedure has been improved upon by modern variations using ablation devices. More limited ablation procedures and hybrid procedures have been introduced, but their efficacy requires further investigation.

P4697Complications and mortality related to non-cardiac surgery in adult congenital heart disease: Results of a nationwide study including 20,450 cases

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G P Diller ◽  
E Freisinger ◽  
L Bronstein ◽  
J Koeppe ◽  
J Gerss ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Adverse Event ◽  
Heart Disease ◽  
Surgical Procedures ◽  
Congenital Heart ◽  
Cardiac Surgical Procedures ◽  
Mortality Rates ◽  
Adverse Event Rate ◽  
Major Adverse Event ◽  
Mortality And Morbidity

Abstract Background Adults with congenital heart disease (ACHD) represent a growing patient population with high morbidity and increasing health resource utilization. In addition to acute and chronic cardiac complications, these patients require numerous non-cardiac surgical procedures during their life-time. Limited data on the morbidity and mortality risk related to non-cardiac surgical procedures exist in contemporary CHD patients. The aim of this study was to analyse the frequency and outcome of non-cardiac surgical procedures in contemporary ACHD patients based on all hospital admissions in Germany between 2011 and 2016. Methods Based on the German diagnosis related groups data of patients treated between 2011 and 2016 we identified all ACHD patients treated surgically as inpatients for non-cardiac problems. The dataset contains information on patient demographics, primary and secondary diagnoses, interventional or surgical procedures, duration of stay and outcome including mortality. The primary endpoint of the study was surgery related mortality as well as major adverse events (defined as death or myocardial infarction, stroke, pulmonary embolism, sepsis or resuscitation). Results Overall, 48,872 ACHD cases were hospitalized during the study period. Of these, 20,450 (41.8%) were hospitalized for non-cardiac surgical procedures. The median age at surgery was 50.0 years and 62.9% of patients were male. The overall mortality rate following non-cardiac operations was 2.8% (95% CI 2.6–3.0%). The highest mortality rates were observed for procedure codes involving pharynx, larynx or trachea (27.2%; 95% CI: 22.3–32.1%) and lung surgery (15.4%; 95% CI: 13.3–17.8%). Abdominal surgery (9.2%; 95% CI: 7.7–10.9) and neurosurgical procedures (7.8%; 95% CI: 5.4–10.9) also had relative high mortality rates. The major adverse event rate overall was 12.7% (95% CI 11.7–12.7%). The highest major adverse event rates were observed for surgery of the airways (43.2%; 95% CI: 40.2%-46.4%). Conclusions Non-cardiac surgical procedures are common in ACHD patients and are associated with considerable mortality and morbidity in this cohort. Especially, surgical procedures involving the airways or neurosurgery emerged as risky procedures. However, even for routine abdominal or orthopaedic surgery considerable mortality and morbidity was observed. Overall, our data support careful pre-operative patient evaluation and concentration of surgical procedures at centres with extensive surgical and anaesthetic experience with ACHD patients.

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