Association of Tissue Factor Polymorphism with Fibrinolysis and Excessive Bleeding after Open Heart Surgery: A preliminary report / 대한마취과학회지

BACKGOUND: Fibrinolysis, which commonly occurs following cardiopulmonary bypass (CPB), may be related to the excessive bleeding (EB) and morbidity after CPB. It is known that tissue factor (TF), which is triggered by CPB, plays an important role in the initiation of fibrinolysis during and after CPB, however, EB and fibrinolysis after CPB show inter-individual variance. Therefore, in this study, TF -603A/G polymorphism was evaluated to determine if it is associated with fibrinolysis and/or EB and morbidity following CPB. METHODS: RT-PCR was used to determine the TF genotype of each patient. In addition, the amount of blood loss that occurred during the first 24 hours following surgery was documented, and EB was diagnosed when more than 1 L of blood was lost during the first 24 hours following surgery. The D-dimer levels were measured at; a) Time 1; prior to initiation of CPB, b) Time 2; 2 hours after CPB, and c) Time 3; 24 hours after CPB. The oxygen index (OI) was calculated at; 1) OI1; upon admission to the ICU, b) OI2; 24 hrs after admission to the ICU, and c) OI3; 48 hrs after admission to the ICU. The intubation time and the length of the ICU stay were also documented. RESULTS: The serum D-Dimer level of the TF -603AA group (n = 72) measured at time 3 was higher than that of the TF -603GG/GA group (n = 25) measured at the same time. In addition, the incidence of EB and the intubation time of the TF -603AA group were higher than those of the TF -603GG/GA group. Finally, the OI3 of the TF -603AA group was lower than that of the TF -603GG/GA group. CONCLUSIONS: The G allele that is associated with TF -603A/G polymorphism may be protective against fibrinolysis following CPB, therefore, it may also be protective against EB and morbidity following CPB.

The Impact of Cardiac Surgery with Deep Hypothermic Circulatory Arrest on Systemic Inflammatory Response and Postoperative Morbidity in Adults

BACKGROUND: The inflammatory response to cardiopulmonary bypass (CPB) surgery is believed to play an important role in the end organ dysfunction after open heart surgery. The effect of temperature on the post-bypass inflammatory response has been studied in normothermic and hypothermic patients. This study compared the influence on the systemic inflammatory response and postoperative morbidity in hypothermic cardiopulmonary bypass patients with those in patients in deep hypothermic circulatory arrest. METHODS: Fifty patients undergoing elective redo-valvular replacement or double valve replacement using a hypothermic cardiopulmonary bypass (26-28oC, H Group) and 9 patients undergoing an elective ascending aortic aneurysm replacement using deep hypothermic circulatory arrest (16oC, D Group) were prospectively investigated. The serum samples were collected to estimate the interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha levels immediately after induction, 30 min after the initiation of the CPB, 30 min after weaning from the CPB, 2 hours after the CPB, 24 hours after the CPB. RESULTS: Patients preoperative and intraoperative characteristics (age, gender, aortic cross clamping time, cardiopulmonary bypass time) were not similar in the two groups. The serum level of IL-6 and TNF-alpha were also similar in the two groups. There were no statistical differences in the intubation time, ICU stay and oxygenation index (arterial PO2/inspired fraction of oxygen). There were also no statistical differences in the incidence of systemic inflammatory response syndrome and the APACHE II scores. CONCLUSIONS: Deep hypothermic circulatory arrest was not shown to produce a more profound inflammatory response or influence the postoperative morbidity than a hypothermic cardiopulmonary bypass.

The Causes of Delaying or Cancellation of the Elective Surgery in Pediatric Patients / 대한마취과학회지

We examined the causes of delaying or cancellation of the elective surgery at Seoul National University Children's Hospital. The total numbers of pediatric patient for the elective surgery during September 1, 1994, to November 30, 1994, were 1287 and that of delaying or cancellation of surgery were 135. The fraction of medical causes of delaying of the elective surgery was 62.2%, and that of non-medical causes of the elective surgery was 36.3%, and 1.5% was unknown. The single most frequent cause was upper respiratory infection, 42.2% of total delays, and the second was that patient had not be admitted as 16.3%o of total delays. The third frequent cause was no indication for surgery as 6.7%, the fourths were fever and inadequate preparation for surgery (5.2%), and the sixth was that the patient had refused to give an informed consent (3.7%), etc.

Causes of Cancellation of Elective Operations in Pediatric Patients / 대한마취과학회지

A analysis was performed on 1716 pediatric surgical patients, who were supposed to receive elective operations at Seoul National University Childrens Hospital from March 2, 1991 to June 29, 1991. The results can be summarized as follows; 1) Overall cancelled ratio was 19.6%. 2) Departmental distribution of delayed/cancelled elective operations, Plastic surgery 27.0%, pediatric surgery 26.1%, neurosurgery 20.3%, cardiothoracic surgery 18.1%, orthopedic surgery 18.0%, ENT 15.6 ophthalmology 13.9% and urology 13.8%. 3) Major causes of delay/cancellation of elective operatios; Abnormal history and physical examination 54.3 , non-medical 35.0% and abnormal laboratory data only 10.7%. 4) Detailed causative factors of delay/cancellation of elective operations, URI 30.6%, notadmitted 27.9%, heavy schedule 5.9%, abnormal LFT 5.3%, FUO 4.2%, abnormal PTT/PT 2.4%, arrhythmia and cardiac disease 2.4% and further diagnostic evaluation needed 1.8%.