Aortic valve replacement in a patient with the prothrombin 20210A mutation.

Patients presenting for cardiac surgery with hypercoagulable states pose a challenge. Although preoperative functional and genetic screening for hypercoagulable disorders may provide pathophysiologic information, it is difficult to make preoperative hematologic management plans in the absence of consensus guidelines, prospective studies, or case reports. We document the first case of prothrombin 20210A mutation in a patient undergoing elective aortic valve replacement. Peri-procedural bridging with heparin and avoidance of antifibrinolytic agents represent salient features of our successful perioperative management.

Early results of a comprehensive operative and perfusion strategy to attenuate the incidence of adverse neurological outcomes in on-pump coronary artery bypass grafting (CABG) patients.

Adverse neurological events, both focal (Type I) and non-focal (Type II), have been appreciated in postoperative on-pump coronary artery bypass grafting (CABG) patients for many years. Advanced age is a significant risk factor for adverse neurological events following CABG surgery. With full knowledge that our elderly population of patients was at high risk for these untoward neurological events, we adopted a comprehensive operative and perfusion strategy in an attempt to attenuate the incidence of these complications. Our strategy included efforts to minimise the number of emboli generated during the operation, avoid cerebral hypoperfusion, and attenuate the systemic inflammatory response. From 15 August 2002 to 31 December 2005, we performed 355 on-pump CABG operations. The incidence of Type I focal injury was 0/355 (0%), the incidence of Type II non-focal injury was 9/355 (2.5%), and postoperative mortality was 2/355 (0.6%). These results compared favorably to the results predicted by the Society of Thoracic Surgeons' (STS) model, and may suggest efficacy.