Use of Aprotinin in the Control of Bleeding During Cardiopulmonary Bypass Surgery: Current Status

1998 ◽  
Vol 4 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Roque Pifarrè
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Bypass Surgery ◽  
Whole Body ◽  
Current Status ◽  
Blood Transfusions ◽  
Donor Blood ◽  
Excessive Bleeding

Excessive bleeding is one of the major complica tions of cardiac surgery with cardiopulmonary bypass (CPB). This complication is related to the operation and the defects in hemostasis induced by extracorporeal circulation. The system atic effects of CPB are called whole body inflammatory reac tion. Heparin, platelet dysfunctions, and fibrinolysis are the major causes of bleeding problems associated with CPB. Dif ferent pharmacological approaches have been used to reduce bleeding and the need for blood transfusions in patients under going cardiac surgery. The most effective is aprotinin, a serum protease inhibitor that is an antifibrinolytic with a platelet- preserving action. It inhibits the activation of the intrinsic co agulation system. Aprotinin therapy effectively reduces blood loss and donor blood requirements. According to most reports, it does not increase the risk of acute myocardial infarction, renal dysfunction, and mortality.

scholarly journals Staged medical aid in acute myocardial infarction management as a key for successful treatment of elderly patients with severe comorbidities

2014 ◽  
Vol 95 (4) ◽  
pp. 593-596
Author(s):  
I F Yakupov ◽  
A S Galyavich ◽  
K V Korchagina
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Elderly Patients ◽  
Successful Treatment ◽  
Bypass Graft ◽  
Stable Condition

During the recent years, since the start of coronary artery stent era not only coronary artery bypass graft surgery, but percutaneous transluminal angioplasty became common in patients with left main coronary artery stenosis. Mechanical complications of myocardial infarction, such as ventricular septal rupture, left ventricle free wall rupture and mitral regurgitation due to papillary muscle rupture, are straight indications for cardiac surgery. However, studies show that the age of over 70 years is a high-risk factor for cardiac surgery. In elderly patients, the duration of cardiopulmonary bypass and aortic cross-clamping time have a major impact on the surgery outcome. Therefore, strategies aimed at reducing the volume of cardiac surgery, should be more successful in elderly patients. On the other hand, elderly patients should be well prepared for surgery, and it should be performed when concomitant diseases are compensated. A case of 82-year patient admitted to the intensive care unit with acute myocardial infarction and chord papillary muscles partial rupture associated with severe mitral regurgitation, is presented. Due to the progression of pulmonary edema, mechanical ventilation was started and emergency percutaneous intervention was administered as a life-saving measure. Stents were placed in obtuse marginal branch, circumflex artery and anterior interventricular artery. Because of existing mitral regurgitation of 3-4 grade, after 2 weeks the patient was re-evaluated ex consilio. Considering relatively stable condition, mitral valve replacement with cardiopulmonary bypass was administered, which was successfully done. The successful treatment of this patient was possible because of the proper and timely staging of the patient’s management.

Five-Year Follow-Up of the Medicine, Angioplasty, or Surgery Study (MASS)

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Whady A. Hueb ◽  
Paulo Rogério Soares ◽  
Sérgio Almeida de Oliveira ◽  
Shiguemituzo Ariê ◽  
Rita Helena A. Cardoso ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Medical Treatment ◽  
Medical Therapy ◽  
Stable Angina ◽  
Coronary Angioplasty ◽  
Bypass Surgery ◽  
Random Assignment

Background —Although coronary angioplasty and myocardial bypass surgery are routinely used, there is no conclusive evidence that these interventional methods offer greater benefit than medical therapy alone. This study is intended to evaluate, in a prospective, randomized, and comparative analysis, the benefit of the 3 current therapeutic strategies for patients with stable angina and single proximal left anterior descending coronary artery stenosis. Methods and Results —In a single institution, 214 patients with stable angina, normal ventricular function, and severe proximal stenosis (>80%) on the left anterior descending artery were selected for the study. After random assignment, 70 patients were referred to surgical treatment, 72 to angioplasty, and 72 to medical treatment. The primary end points were the occurrence of acute myocardial infarction or death and presence of refractory angina. After a 5-year follow-up, these combined events were reported in only 6 patients referred to surgery as compared with 29 patients treated with angioplasty and 17 patients who only received medical treatment ( P =0.001). However, no differences were noted in relation to the occurrence of cardiac-related death in the 3 treatment groups ( P =0.622). No patient assigned to surgery needed repeat operation, whereas 8 patients assigned to angioplasty and 8 patients assigned to medical treatment required surgical bypass after the initial random assignment. Surgery and angioplasty reduced anginal symptoms and stress-induced ischemia considerably. However, all 3 treatments effectively improved limiting angina. Conclusions —Bypass surgery for single-vessel coronary artery disease is associated with a lower incidence of medium-term and long-term events as well as fewer anginal symptoms than that found in the patients who underwent angioplasty or medical therapy. In this study, coronary angioplasty was only superior to medical strategies in relation to the anginal status. However, the 3 treatment regimens yielded a similar incidence of acute myocardial infarction and death. Such information should be useful when choosing the best therapeutic option for similar patients.

scholarly journals Serial determinations of serum enzymes following Aorta-Coronary bypass surgery and acute myocardial infarction.

1985 ◽  
Vol 26 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Kozui MIYAZAWA ◽  
Haru FUKUYAMA ◽  
Ichiro YAMAGUCHI ◽  
Minoru KOBAYASHI ◽  
Masahiko WASHIO ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Bypass Surgery ◽  
Coronary Bypass ◽  
Serum Enzymes ◽  
Coronary Bypass Surgery
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