ABSTRACT
BACKGROUND: The addition of 6% hydroxyethyl starch (HES) into Ringer lactate priming solution may have adverse effects on hemostasis in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) with or without the use of tranexamic acid. METHODS: In a prospective, randomized clinical trial, 132 patients were assigned to receive 20 ml/kg of Ringer priming solution with or without tranexamic acid (TA) (Group RS-TA, n=34 and Group RS-noTA, n=32) or 10 ml/kg of 6% HES plus 10 ml/kg of RS priming solution with or without intravenous tranexamic acid (Group HES-TA, n=35 and Group HES-noTA, n=31). Estimated blood loss, chest tube drainage, amount of blood products, hemoglobin, hematocrit, platelet and coagulation parameters were examined before and 24 hour after surgery. RESULTS: For Group HES with tranexamic acid, when compared to other groups, estimated blood loss, postoperative 24 hour drainage loss and blood product transfusions were less (P=0.023; P=0.003; P=0.001; respectively) and hemoglobin, hematocrit values at 12 and 24 hours after surgery increased in comparison to other groups (P=0.041, P=0.034, P=0.004, P=0.001; respectively). Platelet concentrations were similar between groups (P>0.05). CONCLUSIONS: In CABG, the administration of tranexamic acid in HES 130/0.4 prime solution study group decreased estimated blood loss and chest tube drainage in comparison to patients receving Ringer prime solution with or without tranexamic acid postoperatively however, no effects on renal functions or postoperative complications were shown.
Subject(s)
Bacteremia/diagnosis , Brucellosis/diagnosis , Coronary Artery Disease/diagnosis , Embolism/diagnosis , Endocarditis, Bacterial/diagnosis , Myocardial Infarction/diagnosis , Bacteremia/etiology , Bacteremia/therapy , Brucellosis/complications , Brucellosis/therapy , Coronary Artery Disease/etiology , Coronary Artery Disease/therapy , Embolism/etiology , Embolism/therapy , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/therapy , Humans , Male , Middle Aged , Myocardial Infarction/etiology , Myocardial Infarction/therapyABSTRACT
AIM: The medium term patency rate of proximal saphenous vein conduit anastomosed onto the aortic dacron graft in patients was investigated. METHODS: Forty-eight patients who underwent aortic graft replacement and coronary artery bypass grafting (CABG) in our clinic between February 2004 and December 2011 were included in the study. The study was designed as two phases. In the first phase, records of the patients who have undergone ascending aorta replacement with concomitant CABG were scanned retrospectively. In the second phase, saphenous vein graft patency was assessed in living patients with multislice computerized tomography (CT) by cross-sectional prospective study. RESULTS: A total of 61 saphenous vein grafts (SVG) were used in patients who have undergone concomitant CABG. A total of 39.6% of the patients had single vessel disease, 45.8% of the patients had two-vessel disease and 14.6% three-vessel or more disease. The mean follow-up duration was 3.7±1.9 years. SVG cumulative patency rate was 45.9%. Although the coronary artery position in which the saphenous graft was least occluded was the left anterior descending artery (9.1%) and the position in which it was most occluded was right coronary artery (51.5%), there was no statistically significant difference among the coronary positions in which the SVG was used (p>0.05). CONCLUSION: The saphenous vein conduit anastomosed to the aortic dacron graft may have negative effects on graft patency. The placement of saphenous vein on a native tissue like the innominate artery may have beneficial effects of graft patency by slowing down neointimal hyperplasia.
