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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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The Journal of Cardiovascular Surgery 1999 Febbraio;40(1):37-43

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Acute nor­mov­o­lemic hemo­di­lu­tion (ANH) in sur­gery of the thora­co-ab­dom­inal ­aorta. A ­cohort ­study to eval­uate coag­u­la­tion param­e­ters and ­blood prod­ucts utiliza­tion

Cinà C. S., Bruin G. *

From the Depart­ment of Sur­gery * Depart­ment of Anes­thesia Ham­ilton ­Health Sci­ences Cor­po­ra­tion Ham­ilton, ­Ontario, ­Canada

Objec­tive. To ­assess ­whether a mod­i­fied tech­nique of ­acute nor­mov­o­lemic hemo­di­lu­tion (ANH) ­reduces the util­iza­tion of ­blood prod­ucts and ­donor expo­sures, and/or ­improves hemo­stasis in sur­gery of the thor­a­coab­dom­inal ­aorta.
Methods. Experi­mental ­design: ­cohort ­study com­paring fif­teen con­trol ­patients and ­seven ­treated ­with the ­adjunct of ANH. ­Mean ­follow-up 23 (SD=15.4) ­months.
Set­ting: com­mu­nity hos­pital ­acting as a ­referral ­centre for vas­cular dis­eases. ­Patients’ selec­tion: ­Thirty ­patients ­between 1990 and 1995 ­were ­entered ­into the ­study, ­eight ­were ­excluded ­because of rup­ture. Inter­ven­tions: the ANH tech­nique ­used the with­drawal of up to 3000 ml ­blood ­during the ­time ­between induc­tion of anes­thesia and ­clamping of the tho­racic ­aorta. Col­loids ­were pref­e­ren­tially ­used for replace­ment ­together ­with up to ­three ­units of ­packed red ­blood ­cells (PRC). The autol­o­gous ­blood was retrans­fused ­during the ­final ­phases of the pro­ce­dure. Meas­ures: Param­e­ters meas­ured ­included pre- and post­op­er­a­tive PTT, INR, and plate­lets; the quan­tity of ­stored ­blood prod­ucts and ­total ­donor expo­sures.
­Results. ­Blood ­losses, PRC trans­fused, and post­op­er­a­tive hemo­globin con­cen­tra­tion ­were not sta­tis­ti­cally dif­ferent in the two ­groups. ­Repeated meas­ures Anal­ysis of var­i­ance on coag­u­la­tion param­e­ters ­showed ­lower PTT ­values (F1,20=4.2, p=0.05) and ­higher ­platelet con­cen­tra­tion (F1,20=8.2, p=0.01) ­after sur­gery in the ANH ­group. In the ­latter, the reduc­tion in ­fresh ­frozen ­plasma (FFP) util­iza­tion did not ­reach sta­tis­tical sig­nif­i­cance (T19.5=1.79, p=0.08). ­This ­group, how­ever, ­required ­fewer trans­fu­sions of plate­lets (T20=4.27, p=0.0004), and cryop­re­cip­i­tate (T20=2.52, p=0.02), and no coag­u­la­tion ­adjuncts (­dDAVP, ­epsilon-ami­no­ca­proic ­acid), (­Fisher’s ­test=0.04). ­Total ­donor expo­sures was ­also sig­nif­i­cantly ­lower in the ANH ­group (T20=3.28, p=0.003).
Con­clu­sions. The ANH tech­nique ­reduces homol­o­gous trans­fu­sions and ­donor expo­sures, and has a ben­e­fi­cial ­effect on hemo­stasis. More­over, the tech­nique may be ­useful in the man­age­ment of ­cross ­clamping hyper­ten­sion.

lingua: Inglese


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