ABSTRACT
Heparin-induced thrombocytopenia (HIT) has become more prevalent in today's cardiac setting and has resulted in the need for alternative anticoagulant therapies. Danaparoid sodium, one alternative to heparin, has been used in six cardiopulmonary bypass procedures in this hospital. This clinical experience has resulted in the progressive refinement of a protocol for the 'safe' clinical use of danaparoid sodium. Although there were six positive outcomes with the use of danaparoid sodium, alternatives must be explored in order to find the optimal anticoagulant for the treatment of HIT.
Subject(s)
Cardiopulmonary Bypass/methods , Chondroitin Sulfates/administration & dosage , Dermatan Sulfate/administration & dosage , Heparitin Sulfate/administration & dosage , Thrombocytopenia/drug therapy , Adult , Aged , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Anticoagulants/standards , Cardiopulmonary Bypass/adverse effects , Chondroitin Sulfates/adverse effects , Chondroitin Sulfates/standards , Dermatan Sulfate/adverse effects , Dermatan Sulfate/standards , Drug Combinations , Female , Hemorrhage/chemically induced , Heparin/adverse effects , Heparitin Sulfate/adverse effects , Heparitin Sulfate/standards , Humans , Male , Middle Aged , Postoperative Complications/blood , Postoperative Complications/chemically induced , Thrombocytopenia/chemically inducedABSTRACT
Clinical perfusionists must be able to modify the existing extracorporeal circuit in order to accommodate a specific surgical pathology. The clipping of a giant intracranial middle cerebral artery aneurysm, unapproachable with conventional neurosurgical techniques, required the use of a modified closed cardiopulmonary bypass circuit combined with deep hypothermia and total circulatory arrest. In-hospital discussions with anaesthesia, cardiac surgery, neurosurgery, and cardiology enabled an informed team approach directed towards the successful treatment of this complex neurosurgical lesion.
Subject(s)
Extracorporeal Circulation/instrumentation , Intracranial Aneurysm/surgery , Catheterization, Peripheral , Equipment Design , Femoral Artery , Femoral Vein , Humans , Hypothermia, InducedABSTRACT
Myocardial injury was assessed with the use of enzyme indexes in 40 patients randomly assigned to one of two groups undergoing coronary artery bypass surgery. Twenty patients received cold cardioplegia delivered by retrograde coronary sinus perfusion and 20 received cardioplegic solution by anterograde aortic root perfusion. Creatine kinase isoenzyme MB and lactate dehydrogenese isoenzyme 1 and isoenzyme 2 assays were carried out on blood samples obtained from the coronary sinus before aortic cross-clamping and 0, 5, and 30 min after aortic unclamping. Levels of these enzymes were also obtained from venous blood samples before aortic cross-clamping and 3, 8, 14, and 20 hr after aortic unclamping and 2, 3, 4, and 5 days after surgery. Preoperative and postoperative hemodynamic measurements (Swan-Ganz catheter) and radionuclide wall motion studies were also obtained for comparison. There was no overall significant difference between the two groups postoperatively in terms of enzyme indexes, hemodynamic measurements, or results of wall motion studies. We conclude that retrograde coronary sinus perfusion is an alternative to aortic root perfusion in delivering cold cardioplegia. More studies are required to determine which subgroup of patients with coronary artery disease may benefit from retrograde coronary perfusion.