Heparin Anticoagulation during Cardiopulmonary Bypass for Thoracoabdominal Aorta Replacement in a Patient with a History of Heparin-Induced Thrombocytopenia / 日本心臓血管外科学会雑誌

Immune heparin-induced thrombocytopenia (HIT) is a crucial side effect of heparin therapy. We report the case of a 52-year-old man who was strongly suspected of having HIT after urgent descending aorta replacement. This case required continuous hemodiafiltration (CHDF) anticoagulated with unfractionated heparin (UFH) for acute renal failure after the operation. The patient developed thrombocytopenia and thrombus emphraxis in the circuit on the seventh day and was suspected of having HIT. UFH was ceased and replaced with argatroban. After then, thrombus emphraxis was not seen in the circuit and the platelet count was recovered promptly. He tested positive in an enzyme-linked immunosorbent assay for anti-platelet factor 4/heparin antibodies (anti-PF4/H Abs). Six months later, we found, an expanding thoracoabdominal aortic aneurysm and performed thoracoabdominal aorta replacement. We selected heparin anticoagulation for cardiopulmonary bypass because anti-PF4/H Abs were negative at that time. Thrombus emphraxis was not found during the operation. The patient developed neither thrombocytopenia nor thrombosis in the perioperative period.

Validity of Emergency Thoracic Aortic Surgery in Octogenarians / 日本心臓血管外科学会雑誌

Between January 1994 and October 2004, 87 patients underwent emergency thoracic aortic surgery. Of these, 11 patients were more than 80 years old (O-group) and 76 were less than 80 years old (Y-group). A total of 58 patients (6 in O-group and 52 in Y-group) were treated for acute type-A aortic dissection, 5 (0 in O-group and 5 in Y-group) for acute type-B aortic dissection and 21 (4 in O-group and 17 in Y-group) for the involved rupture of a thoracic aortic aneurysm. The operative procedures consisted of the replacement of either the ascending, or the ascending and transverse aorta in 71 patients (8 in O-group and 63 in Y-group), and the replacement of the distal descending aorta in 15 patients (3 in O-group and 12 in Y-group). The operative mortality rates were 27.2% (3 patients) and 19.7% (15 patients) in the O- and Y-groups, respectively, with no significant difference between the groups. The rate of early complications, including circulatory failure, respiratory failure and cerebral infarction, did not statistically differ between the 2 groups. The overall 2-year survival rates of the patients who survived the operation were 83.3% in the O-group and 95.1% in the Y-group. Moreorer, 75% of the patients (6 of 8) who survived the surgery regained normal activities of daily life after the surgery, at a level similar to before the surgery. The present data indicates that emergency thoracic aortic surgery can be justified in selected in octogenarian patients.

A Successful Case of Mitral Valve Repair after Percutaneous Transluminal Carotid Angioplasty with Stenting / 日本心臓血管外科学会雑誌

A 75-year-old man with severe mitral valve regurgitation and 80% stenosis of the right internal carotid artery was referred to us for surgical treatment. He had a history of ipsilateral cerebral artery thrombosis 28 months previously. Although preoperative percutaneous transluminal carotid angioplasty with stenting (PTCAS) was performed, 60% stenosis of the artery still remained. He underwent mitral valve repair 2 months after PTCAS due to cardiac symptom progression. Intraaortic balloon pumping was used to maintain higher pressure during the extracorporeal circulation of the heart surgery. He recovered uneventfully and without any cerebral complications.