ABSTRACT
From May 1981 through April 1996, 19 patients with ruptured abdominal aortic aneurysm were admitted to our department. There were 18 men and 1 woman with a mean age of 69 years. Fifteen cases were in shock with a systolic blood pressure<80mmHg and 4 cases required chest compression for hypotension. One patient died of cardiac arrest on the operating table, 3 died of multiple organ failure or respiratory failure in hospital. The overall mortality rate was 21%. The mortality rate of patients under the age of 70 years was 10%, whereas that for those over 70 years of age was 33%. We believe that the use of intraoperative ileal tubing and postoperative continuous hemofiltration would improve the mortality rate in cases of ruptured abdominal aortic aneurysms.
ABSTRACT
Cardiac rupture remains a severe complication after acute myocardial infarction (AMI) and its prognosis is poor. Between February 1985 and February 1995, six male patients (age range, 59 to 76 years, average 65.2) underwent repair of heart rupture after AMI at our clinic. The time interval between heart rupture and emergency surgery ranged from one hour to 24 hours (average 11 hours). Two patients did not recover from the initial shock, and were treated by emergency operation under IABP or PCPS. These two patients both had the blow-out type of heart rupture, and were treated by the felt-sandwich method. Neither patient was cured, due to uncontrollable bleeding. The other 4 patients recovered from circulatory catastrophe after pericardial drainage, and surgery was then carried out. One blow-out type patient died of bleeding. Two cases of hemorrhagic dissecting type were successfully treated by the felt-sandwich method. One oozing type case was treated with fibrin-glue and good results were obtained. The hemorrhagic dissecting type or oozing type showed good results but the blow-out type showed poor results. Initial pericardial drainage after establishing the diagnosis and gentle handling of the heart is essential to obtain good results. For the blow-out type of repture, other strategy is needed to control bleeding and facilitate recovery from shock.
ABSTRACT
The purpose of this study was to determine the effect of intraoperative autologous blood salvage during elective abdominal aortic aneurysm repair with Cell Saver 4 (Heamonetics Inc.). Fifty patients prospectively received intraoperative autologous transfusion (Group CS; <i>n</i>=50, 1991-94) and 25 received no intraoperative autologous transfusion (Group NCS; <i>n</i>=25, 1983-91). Only 7 patients in Group NCS received no homologous blood (28%), while 43 in Group CS received autologous blood transfusion (86%). There was no difference between the groups with respect to postoperative platelets counts or serum concentrations of total protein, albumin, BUN and LDH. We conclude that the use of the Cell Saver 4 reduces perioperative homologous blood during elective aortic aneurysm repair.