Can plasma fibrinogen levels predict bleeding after coronary artery bypass grafting?

BACKGROUND: Fibrinogen is the main biomarker for bleeding. To prevent excessive postoperative bleeding, it would be useful to identify high-risk patients before coronary artery bypass grafting (CABG). OBJECTIVES: In order to predicating bleeding after CABG, we sought to determine whether preoperative fibrinogen concentration was associated with the amount of bleeding following CABG. PATIENTS AND METHODS: A total of 144 patients (mean age = 61.50 ± 9.42 years; 65.7% men), undergoing elective and isolated CABG, were included in this case-series study. The same anesthesia technique and medicines were selected for all the patients. In the ICU, the patients were assessed in terms of bleeding at 12 and 24 hours post-operation, amount of contingent blood products received, and relevant tests. Statistical tests were subsequently conducted to analyze the correlation between preoperative fibrinogen concentration and the amount of post-CABG bleeding. RESULTS: The mean ± standard deviation of bleeding at 12 and 24 hours post-operation was 285.37 ± 280.27 and 499.31 ± 355.57 mL, respectively. The results showed that postoperative bleeding was associated with different factors whereas pre-anesthesia fibrinogen was not correlated with bleeding at 12 (P = 0.856) and 24 hours (P = 0.936) post-operation. There were correlations between the extra-corporal circulation time and bleeding at 12 hours post-operation (ρ = 0.231, P = 0.007) and bleeding at 24 hours post-operation (ρ = 0.218, P = 0.013). CONCLUSIONS: Preoperative assessment of plasma fibrinogen levels failed to predict post-CABG bleeding.

Lutembacher's Syndrome Associated with Meningioma.

A 49-year-old man with Lutembacher's syndrome associated with frontal meningioma referred to our hospital. He also suffered from exertional dyspnea. Transthoracic echocardiography demonstrated mitral valve area of 1.48 cm2, moderate mitral stenosis, and left atrial dimension (LAD) of 5.6 cm with no clot. TEE revealed severe mitral stenosis, mitral valve area of 1.05 cm2 with wilkins 8-10 score, ejection fraction of 50%, and enlarged left atrium (LAD = 5.8 cm) with no clot. Induction of anesthesia was commenced taking into account the patient's specific circumstances, which meant the risk of surgery was high. During surgery, the mitral valve was replaced and the atrial septal defect was repaired without a patch. This case underscores the significance of the adoption of an appropriate therapeutic strategy in the treatment of Lutembacher's syndrome with meningioma before meningioma surgery.