ABSTRACT
El incremento de intervenciones quirúrgicas y su mayor complejidad y agresividad, especialmente en cirugía cardiovascular y trasplantes, junto con el envejecimiento de la población ha supuesto un considerable aumento de la demanda de transfusión sanguínea y derivados hemáticos. Los riesgos médicos inherentes al uso de sangre homóloga, el rechazo por motivaciones personales, éticas o creencias religiosas y una insuficiente disponibilidad de hemoderivados consecuencia de la escasezde donaciones, ha condicionado la necesidad del desarrollo de procesos de ahorro de sangre en cirugía y la búsqueda de técnicas alternativas a la transfusión. Problemática que alcanza su máxima expresión en cirugía cardiaca bajo circulación extracorpórea, como consecuencia del alto consumo de sangre de los enfermos cardiológicos intervenidos. Con la experiencia que aporta un promedio de quinientas cirugías anuales de corazón se realiza una revisión sobre las diferentes medidas y procedimientos asociados al ahorro de sangre en cirugía, especialmente en cirugía cardiovascular (AU)
The increase in the number of operations and their greater complexity and aggressiveness, especially in cardiovascular surgery and transplants, together with the aging of the population, has entailed an increase in the demand for transfusion and haematological derivates. The inherent medical risks of homolog blood usage, rejection for personal motivations, ethical and religious beliefs and insufficient availability of haematological derivates as a consequence of the shortage of donations, have conditioned the necessity for the development of processes for saving blood during surgery and the search for alternative techniques to transfusion. This is a problem which has its highest repercussions in cardiac surgery with cardio-pulmonary by-pass because of the high consumption of blood of patients undergoing cardiac surgery. With the experience of approximately 500 operations per year a review of the different measures and procedures associated with saving blood in surgery has been carried out, especially with regard to cardiovascular surgery (AU)
Subject(s)
Humans , Cardiac Surgical Procedures/methods , Blood Transfusion, Autologous , Operative Blood Salvage/methods , Postoperative Hemorrhage/therapy , Aprotinin/therapeutic use , Blood Coagulation Disorders/complications , Heart Diseases/surgery , Antifibrinolytic Agents/therapeutic useABSTRACT
BACKGROUND AND OBJECTIVES: Exposure of lateral and inferior coronary vessels during off-pump coronary artery bypass grafting may cause significant hemodynamic compromise due to right ventricular compression when tilting the heart. Some new right ventricular assistance devices have been developed in order to avoid this problem but only a few series have been published. A preliminary experience with a right heart circulatory support system is reported. METHODS: A total of eight patients underwent off-pump coronary artery bypass grafting using a right heart support device. Technical procedure and clinical outcome are analyzed. RESULTS: The right heart circulatory support device insertion and management were performed without any complication. A total of 21 distal coronary anastomoses were completed. They were located on the anterior descending artery(8), circumflex branches(6), diagonal branches(2), posterior descending artery(3) and right coronary artery(2). The right ventricular support device delivered flow at a medium rate of 2.2 L/min, providing hemodynamic stability when tilting the heart and exposing the coronary arteries. CONCLUSIONS: The use of right heart support devices is a simple and low risk procedure which may facilitate surgical anastomoses on lateral and inferior epicardial vessels during off-pump coronary artery surgery.
