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Papers by Jens Fassl

Research paper thumbnail of Perioperative administration of fibrinogen does not increase adverse cardiac and thromboembolic events after cardiac surgery

British Journal of Anaesthesia, 2014

ABSTRACT Although infusion of fibrinogen concentrate is increasingly used in bleeding patients af... more ABSTRACT Although infusion of fibrinogen concentrate is increasingly used in bleeding patients after cardiac surgery, safety data are scarce. We aimed to evaluate the effect of perioperative administration of fibrinogen concentrate on postoperative morbidity and mortality in patients undergoing cardiac surgery.

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Research paper thumbnail of P158: Posting a management dashboard improves behaviour in the OR

Antimicrobial Resistance and Infection Control, 2013

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Research paper thumbnail of Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: a prospective, randomized trial

Aortic surgical procedures requiring hypothermic circulatory arrest are associated with altered h... more Aortic surgical procedures requiring hypothermic circulatory arrest are associated with altered hemostasis and increased bleeding. In a randomized clinical trial, we evaluated effects of thromboelastometrically guided algorithm on transfusion requirements. Fifty-six consecutive patients (25 with acute type A dissection) undergoing aortic surgery with hypothermic circulatory arrest were enrolled in a randomized trial during a 6-month period. Patients were randomly allocated to treatment group (n = 27) with thromboelastometrically guided transfusion algorithm or control group (n = 29) with routine transfusion practices (clinical judgment-guided transfusion followed by transfusion according to coagulation test results). Primary end point was cumulative allogeneic blood units (red blood cells, fresh-frozen plasma, and platelets) transfused. Transfusion of allogeneic blood was significantly reduced in the thromboelastometry group: median 9.0 units (interquartile range, 2.0-30.0 units) versus. 16.0 units (9.0-23.0 units, P = .02). Most significant decrease was in the use of fresh-frozen plasma (3.0 units, 0-12.0 units, vs 8.0 units, 4.0-18.0 units, P = .005). Postoperative blood loss (890 mL/d, 600-1250 mL/d vs 950 mL/d, 650-1400 mL/d, p = 0.5) and rate of surgical re-exploration (19% vs 24%, P = .7) were similar between groups. Thromboelastometrically guided algorithm significantly decreased need for massive perioperative transfusion (odds ratio, 0.45; 95% confidence interval, 0.2-0.9; P = .03) in multivariable logistic regression analysis. Thromboelastometrically guided transfusion is associated with a decreased use of allogeneic blood units and reduced incidence of massive transfusion in patients undergoing aortic surgery with circulatory arrest.

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Research paper thumbnail of 4 valve endocarditis confirmed by intraoperative transesophageal echocardiography leads to successful quadruple valve replacement

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Research paper thumbnail of Cerebral flow pattern monitoring by transcranial Doppler during cardiopulmonary resuscitation

Anaesthesia and intensive care

We describe the transcranial Doppler pattern during a period of cardiopulmonary resuscitation in ... more We describe the transcranial Doppler pattern during a period of cardiopulmonary resuscitation in a patient undergoing a transcatheter off-pump aortic valve implantation. Transcranial Doppler of the middle cerebral artery flow was measured as a part of a separate ongoing study. The patient developed a cardiac arrest during deployment of the valve prosthesis. The incidental presence of the transcranial Doppler allowed us to assess middle cerebral artery flow during cardiopulmonary resuscitation in real time. An initial lack of a diastolic flow pattern seen with transcranial Doppler at the beginning of cardiopulmonary resuscitation led to volume loading and optimisation of the resuscitation technique. After increasing the depth of external cardiac massage, the cerebral flow pattern improved to produce sufficient diastolic flow. The transcranial Doppler provided additional information during cardiopulmonary resuscitation, which was helpful in clinical management. The use of transcranial Doppler may be helpful for other cardiac procedures where cerebral malperfusion may occur.

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Research paper thumbnail of Lack of agreement between esophageal doppler cardiac output measurements and continuous pulse contour analysis during off-pump cardiac surgery

Objective: Transesophageal echo-Doppler cardiac output as well as arterial pulse contour analyses... more Objective: Transesophageal echo-Doppler cardiac output as well as arterial pulse contour analyses cardiac output are increasingly used for cardiac output monitoring. No data are available whether both techniques may be used interchangeably in patients undergoing cardiac surgery. Design: Prospective, observational study Setting: Operating rooms of a university affiliated hospital. Patients: 30 patients undergoing elective coronary artery bypass grafting surgery.Interventions: NoneMeasurements: 900 paired cardiac output measurements were obtained by pulse contour analysis following transpulmonary thermodilution equilibration by the PiCCO system (PiCCO, Pulsion, Munich, Germany) and by the HemoSonic esophageal doppler monitor (HemoSonic 100; Arrow International, Reading, PA). Measurements were performed within the first hour after induction of anesthesia. Results: Bland-Altman analysis of the complete data set showed a mean difference (bias) of - 0.12 l/min (95% CI -0.06 to -0.18) with...

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Research paper thumbnail of Major themes for 2010 in cardiothoracic and vascular anesthesia

HSR proceedings in intensive care & cardiovascular anesthesia, 2011

Significant variability in transfusion practice persists despite guidelines. Although the lysine ... more Significant variability in transfusion practice persists despite guidelines. Although the lysine analogues are effective antifibrinolytics, safety concerns exist with high doses tranexamic acid. Despite recombinant activated factor VII promising results in massive bleeding after cardiac surgery, it significantly increases arterial thromboembolic risk. Aortic valve repair may evolve to standard of care. Transcatheter aortic valve implantation is an established therapy for aortic stenosis. The cardiovascular anesthesiologist features prominently in the new guidelines for thoracic aortic disease. Although intense angiotensin blockade improves outcomes in heart failure, it might aggravate the maintenance of perioperative systemic vascular tone. Ultrafiltration is an alternative to diuresis for volume overload in heart failure. Management of heart failure titrated to brain natriuretic peptide activity reduces mortality. A major surgical advance has been the significant outcome improvemen...

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Research paper thumbnail of Transapikale minimal invasive Aortenklappen-Implantation

Zeitschrift für Herz-,Thorax- und Gefäßchirurgie, 2007

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Research paper thumbnail of Hypothermic Circulatory Arrest Using Antegrade Cerebral Perfusion Is Safe for Elective Aortic Arch Surgery

The Thoracic and Cardiovascular Surgeon, 2013

We hypothesized that hypothermic circulatory arrest (HCA) can be performed with a low operative r... more We hypothesized that hypothermic circulatory arrest (HCA) can be performed with a low operative risk and does not add to the morbidity in elective procedures. A total of 178 patients with a mean (± SD) age of 62 (± 10) years underwent HCA for elective aortic surgery from April 2008 to September 2011. Pre- and postoperative clinical data were collected prospectively. Hemiarch replacement was performed in 97% patients. Mean logistic Euroscore I was 17% (± 15). HCA was performed at 26°C bilateral tympanic temperature. Mean HCA duration was 17 (±) min. Mean cross-clamp time was 106 (± 39) min. Overall 30-day mortality was 2% and stroke occurred in 4% of patients. Overall 6-month survival was 96%. Cox regression analysis for 6-month survival revealed four variables with significant influence: the logistic Euroscore I (p = 0.008), age (p = 0.04), cross-clamp time (p = 0.008), and reoperation for bleeding complications (p = 0.04). HCA with open distal anastomosis for elective aortic repair can be performed with low operative mortality, even in the elderly, and seems not to add to the morbidity of the procedure.

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Research paper thumbnail of Transapical aortic valve implantation at one year

The Thoracic and Cardiovascular Surgeon, 2008

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Research paper thumbnail of Preoperative CT scan predicts adverse events after surgery for acute aortic dissection type A

The Thoracic and Cardiovascular Surgeon, 2013

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Research paper thumbnail of Off-Pump aortic valve bypass using a novel prosthesis delivery system

The Thoracic and Cardiovascular Surgeon, 2012

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Research paper thumbnail of Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: A prospective, randomized trial

The Journal of Thoracic and Cardiovascular Surgery, 2010

Aortic surgical procedures requiring hypothermic circulatory arrest are associated with altered h... more Aortic surgical procedures requiring hypothermic circulatory arrest are associated with altered hemostasis and increased bleeding. In a randomized clinical trial, we evaluated effects of thromboelastometrically guided algorithm on transfusion requirements. Fifty-six consecutive patients (25 with acute type A dissection) undergoing aortic surgery with hypothermic circulatory arrest were enrolled in a randomized trial during a 6-month period. Patients were randomly allocated to treatment group (n = 27) with thromboelastometrically guided transfusion algorithm or control group (n = 29) with routine transfusion practices (clinical judgment-guided transfusion followed by transfusion according to coagulation test results). Primary end point was cumulative allogeneic blood units (red blood cells, fresh-frozen plasma, and platelets) transfused. Transfusion of allogeneic blood was significantly reduced in the thromboelastometry group: median 9.0 units (interquartile range, 2.0-30.0 units) versus. 16.0 units (9.0-23.0 units, P = .02). Most significant decrease was in the use of fresh-frozen plasma (3.0 units, 0-12.0 units, vs 8.0 units, 4.0-18.0 units, P = .005). Postoperative blood loss (890 mL/d, 600-1250 mL/d vs 950 mL/d, 650-1400 mL/d, p = 0.5) and rate of surgical re-exploration (19% vs 24%, P = .7) were similar between groups. Thromboelastometrically guided algorithm significantly decreased need for massive perioperative transfusion (odds ratio, 0.45; 95% confidence interval, 0.2-0.9; P = .03) in multivariable logistic regression analysis. Thromboelastometrically guided transfusion is associated with a decreased use of allogeneic blood units and reduced incidence of massive transfusion in patients undergoing aortic surgery with circulatory arrest.

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Research paper thumbnail of Ligation or Distortion of the Right Circumflex Artery During Minimal Invasive Mitral Valve Repair Detected by Transesophageal Echocardiography

Journal of the American Society of Echocardiography, 2008

A 43-year-old male patient undergoing mitral valve repair because of severe mitral regurgitation ... more A 43-year-old male patient undergoing mitral valve repair because of severe mitral regurgitation as a result of P2 prolapse was treated with insertion of neochords and a 36 Carpentier-Edwards physio-ring. After weaning from cardiopulmonary bypass, S-T elevation in leads II, III, and aVF occurred. On transesophageal echocardiography an occlusion or distortion of the circumflex artery by ring sutures was suggested, because coronary flow was no longer detected by color Doppler. Despite stable hemodynamics an angiogram was performed, which confirmed the diagnosis of stenosis of the circumflex artery. During reoperation 4 sutures placed at the P1 segment of the mitral valve annuloplasty were corrected. Transesophageal echocardiography could detect a good flow of the circumflex artery and the electrocardiographic changes disappeared.

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Research paper thumbnail of Transapical Aortic Valve Implantation

Journal of the American College of Cardiology, 2012

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Research paper thumbnail of Transcatheter Aortic Valve Implantation: Is General Anesthesia Superior to Conscious Sedation?

Journal of Cardiothoracic and Vascular Anesthesia, 2011

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Research paper thumbnail of Anesthesia Management for Transapical Transcatheter Aortic Valve Implantation: A Case Series

Journal of Cardiothoracic and Vascular Anesthesia, 2009

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Research paper thumbnail of The Incidence of Intraoperative Awareness in Cardiac Surgery Fast-track Treatment

Journal of Cardiothoracic and Vascular Anesthesia, 2010

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Research paper thumbnail of Transcatheter Aortic Valve Replacement—Part 3: The Central Role of Perioperative Transesophageal Echocardiography

Journal of Cardiothoracic and Vascular Anesthesia, 2012

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Research paper thumbnail of Transfusion of Allogeneic Blood Products in Proximal Aortic Surgery With Hypothermic Circulatory Arrest: Effect of Thromboelastometry-Guided Transfusion Management

Journal of Cardiothoracic and Vascular Anesthesia, 2013

Proximal aortic surgery with hypothermic circulatory arrest (HCA) commonly involves perioperative... more Proximal aortic surgery with hypothermic circulatory arrest (HCA) commonly involves perioperative transfusion of allogeneic blood products, including red blood cells, plasma, and platelets. The authors hypothesized that surgery with HCA could be performed without allogeneic blood products and that a thromboelastometry-guided algorithm would reduce the transfusion of allogeneic blood products. A retrospective analysis of prospectively collected data. Patients with and without thromboelastometry guidance were compared by case-control analysis (n = 62 matched patients) and multivariate regression (n = 194 patients). Single-center university hospital. This study included 194 patients undergoing elective and emergent procedures with HCA involving the proximal aorta. A thromboelastometry-guided treatment algorithm during surgery was used in 153 patients (79%), and conventional coagulation management was used in 41 patients (21%). During surgery and the following 24 hours, allogeneic blood products were transfused in 106 patients (55%). Median (interquartile range) number of allogeneic blood products transfused was 1 unit (0-6 units). Case-control analysis showed lower transfusion rates of red blood cells, plasma, and any allogeneic blood product (all p<0.050) in patients with thromboelastometry guidance. In the multivariate analysis, thromboelastometry guidance was associated with an odds ratio of 0.26 (95% confidence interval, 0.08-0.84; p = 0.025) for the transfusion of any allogeneic blood product. The use of thromboelastometry was not associated with adverse events (odds ratio 0.72; 95% confidence interval, 0.27-1.90; p = 0.507). Allogeneic blood products were avoided in a proportion of patients. The findings further suggest that thromboelastometry-guided coagulation management promoting the use of coagulation factor concentrates decreased the use of allogeneic blood products during complex cardiac surgery.

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Research paper thumbnail of Perioperative administration of fibrinogen does not increase adverse cardiac and thromboembolic events after cardiac surgery

British Journal of Anaesthesia, 2014

ABSTRACT Although infusion of fibrinogen concentrate is increasingly used in bleeding patients af... more ABSTRACT Although infusion of fibrinogen concentrate is increasingly used in bleeding patients after cardiac surgery, safety data are scarce. We aimed to evaluate the effect of perioperative administration of fibrinogen concentrate on postoperative morbidity and mortality in patients undergoing cardiac surgery.

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Research paper thumbnail of P158: Posting a management dashboard improves behaviour in the OR

Antimicrobial Resistance and Infection Control, 2013

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Research paper thumbnail of Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: a prospective, randomized trial

Aortic surgical procedures requiring hypothermic circulatory arrest are associated with altered h... more Aortic surgical procedures requiring hypothermic circulatory arrest are associated with altered hemostasis and increased bleeding. In a randomized clinical trial, we evaluated effects of thromboelastometrically guided algorithm on transfusion requirements. Fifty-six consecutive patients (25 with acute type A dissection) undergoing aortic surgery with hypothermic circulatory arrest were enrolled in a randomized trial during a 6-month period. Patients were randomly allocated to treatment group (n = 27) with thromboelastometrically guided transfusion algorithm or control group (n = 29) with routine transfusion practices (clinical judgment-guided transfusion followed by transfusion according to coagulation test results). Primary end point was cumulative allogeneic blood units (red blood cells, fresh-frozen plasma, and platelets) transfused. Transfusion of allogeneic blood was significantly reduced in the thromboelastometry group: median 9.0 units (interquartile range, 2.0-30.0 units) versus. 16.0 units (9.0-23.0 units, P = .02). Most significant decrease was in the use of fresh-frozen plasma (3.0 units, 0-12.0 units, vs 8.0 units, 4.0-18.0 units, P = .005). Postoperative blood loss (890 mL/d, 600-1250 mL/d vs 950 mL/d, 650-1400 mL/d, p = 0.5) and rate of surgical re-exploration (19% vs 24%, P = .7) were similar between groups. Thromboelastometrically guided algorithm significantly decreased need for massive perioperative transfusion (odds ratio, 0.45; 95% confidence interval, 0.2-0.9; P = .03) in multivariable logistic regression analysis. Thromboelastometrically guided transfusion is associated with a decreased use of allogeneic blood units and reduced incidence of massive transfusion in patients undergoing aortic surgery with circulatory arrest.

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Research paper thumbnail of 4 valve endocarditis confirmed by intraoperative transesophageal echocardiography leads to successful quadruple valve replacement

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Research paper thumbnail of Cerebral flow pattern monitoring by transcranial Doppler during cardiopulmonary resuscitation

Anaesthesia and intensive care

We describe the transcranial Doppler pattern during a period of cardiopulmonary resuscitation in ... more We describe the transcranial Doppler pattern during a period of cardiopulmonary resuscitation in a patient undergoing a transcatheter off-pump aortic valve implantation. Transcranial Doppler of the middle cerebral artery flow was measured as a part of a separate ongoing study. The patient developed a cardiac arrest during deployment of the valve prosthesis. The incidental presence of the transcranial Doppler allowed us to assess middle cerebral artery flow during cardiopulmonary resuscitation in real time. An initial lack of a diastolic flow pattern seen with transcranial Doppler at the beginning of cardiopulmonary resuscitation led to volume loading and optimisation of the resuscitation technique. After increasing the depth of external cardiac massage, the cerebral flow pattern improved to produce sufficient diastolic flow. The transcranial Doppler provided additional information during cardiopulmonary resuscitation, which was helpful in clinical management. The use of transcranial Doppler may be helpful for other cardiac procedures where cerebral malperfusion may occur.

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Research paper thumbnail of Lack of agreement between esophageal doppler cardiac output measurements and continuous pulse contour analysis during off-pump cardiac surgery

Objective: Transesophageal echo-Doppler cardiac output as well as arterial pulse contour analyses... more Objective: Transesophageal echo-Doppler cardiac output as well as arterial pulse contour analyses cardiac output are increasingly used for cardiac output monitoring. No data are available whether both techniques may be used interchangeably in patients undergoing cardiac surgery. Design: Prospective, observational study Setting: Operating rooms of a university affiliated hospital. Patients: 30 patients undergoing elective coronary artery bypass grafting surgery.Interventions: NoneMeasurements: 900 paired cardiac output measurements were obtained by pulse contour analysis following transpulmonary thermodilution equilibration by the PiCCO system (PiCCO, Pulsion, Munich, Germany) and by the HemoSonic esophageal doppler monitor (HemoSonic 100; Arrow International, Reading, PA). Measurements were performed within the first hour after induction of anesthesia. Results: Bland-Altman analysis of the complete data set showed a mean difference (bias) of - 0.12 l/min (95% CI -0.06 to -0.18) with...

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Research paper thumbnail of Major themes for 2010 in cardiothoracic and vascular anesthesia

HSR proceedings in intensive care & cardiovascular anesthesia, 2011

Significant variability in transfusion practice persists despite guidelines. Although the lysine ... more Significant variability in transfusion practice persists despite guidelines. Although the lysine analogues are effective antifibrinolytics, safety concerns exist with high doses tranexamic acid. Despite recombinant activated factor VII promising results in massive bleeding after cardiac surgery, it significantly increases arterial thromboembolic risk. Aortic valve repair may evolve to standard of care. Transcatheter aortic valve implantation is an established therapy for aortic stenosis. The cardiovascular anesthesiologist features prominently in the new guidelines for thoracic aortic disease. Although intense angiotensin blockade improves outcomes in heart failure, it might aggravate the maintenance of perioperative systemic vascular tone. Ultrafiltration is an alternative to diuresis for volume overload in heart failure. Management of heart failure titrated to brain natriuretic peptide activity reduces mortality. A major surgical advance has been the significant outcome improvemen...

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Research paper thumbnail of Transapikale minimal invasive Aortenklappen-Implantation

Zeitschrift für Herz-,Thorax- und Gefäßchirurgie, 2007

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Research paper thumbnail of Hypothermic Circulatory Arrest Using Antegrade Cerebral Perfusion Is Safe for Elective Aortic Arch Surgery

The Thoracic and Cardiovascular Surgeon, 2013

We hypothesized that hypothermic circulatory arrest (HCA) can be performed with a low operative r... more We hypothesized that hypothermic circulatory arrest (HCA) can be performed with a low operative risk and does not add to the morbidity in elective procedures. A total of 178 patients with a mean (± SD) age of 62 (± 10) years underwent HCA for elective aortic surgery from April 2008 to September 2011. Pre- and postoperative clinical data were collected prospectively. Hemiarch replacement was performed in 97% patients. Mean logistic Euroscore I was 17% (± 15). HCA was performed at 26°C bilateral tympanic temperature. Mean HCA duration was 17 (±) min. Mean cross-clamp time was 106 (± 39) min. Overall 30-day mortality was 2% and stroke occurred in 4% of patients. Overall 6-month survival was 96%. Cox regression analysis for 6-month survival revealed four variables with significant influence: the logistic Euroscore I (p = 0.008), age (p = 0.04), cross-clamp time (p = 0.008), and reoperation for bleeding complications (p = 0.04). HCA with open distal anastomosis for elective aortic repair can be performed with low operative mortality, even in the elderly, and seems not to add to the morbidity of the procedure.

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Research paper thumbnail of Transapical aortic valve implantation at one year

The Thoracic and Cardiovascular Surgeon, 2008

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Research paper thumbnail of Preoperative CT scan predicts adverse events after surgery for acute aortic dissection type A

The Thoracic and Cardiovascular Surgeon, 2013

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Research paper thumbnail of Off-Pump aortic valve bypass using a novel prosthesis delivery system

The Thoracic and Cardiovascular Surgeon, 2012

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Research paper thumbnail of Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: A prospective, randomized trial

The Journal of Thoracic and Cardiovascular Surgery, 2010

Aortic surgical procedures requiring hypothermic circulatory arrest are associated with altered h... more Aortic surgical procedures requiring hypothermic circulatory arrest are associated with altered hemostasis and increased bleeding. In a randomized clinical trial, we evaluated effects of thromboelastometrically guided algorithm on transfusion requirements. Fifty-six consecutive patients (25 with acute type A dissection) undergoing aortic surgery with hypothermic circulatory arrest were enrolled in a randomized trial during a 6-month period. Patients were randomly allocated to treatment group (n = 27) with thromboelastometrically guided transfusion algorithm or control group (n = 29) with routine transfusion practices (clinical judgment-guided transfusion followed by transfusion according to coagulation test results). Primary end point was cumulative allogeneic blood units (red blood cells, fresh-frozen plasma, and platelets) transfused. Transfusion of allogeneic blood was significantly reduced in the thromboelastometry group: median 9.0 units (interquartile range, 2.0-30.0 units) versus. 16.0 units (9.0-23.0 units, P = .02). Most significant decrease was in the use of fresh-frozen plasma (3.0 units, 0-12.0 units, vs 8.0 units, 4.0-18.0 units, P = .005). Postoperative blood loss (890 mL/d, 600-1250 mL/d vs 950 mL/d, 650-1400 mL/d, p = 0.5) and rate of surgical re-exploration (19% vs 24%, P = .7) were similar between groups. Thromboelastometrically guided algorithm significantly decreased need for massive perioperative transfusion (odds ratio, 0.45; 95% confidence interval, 0.2-0.9; P = .03) in multivariable logistic regression analysis. Thromboelastometrically guided transfusion is associated with a decreased use of allogeneic blood units and reduced incidence of massive transfusion in patients undergoing aortic surgery with circulatory arrest.

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Research paper thumbnail of Ligation or Distortion of the Right Circumflex Artery During Minimal Invasive Mitral Valve Repair Detected by Transesophageal Echocardiography

Journal of the American Society of Echocardiography, 2008

A 43-year-old male patient undergoing mitral valve repair because of severe mitral regurgitation ... more A 43-year-old male patient undergoing mitral valve repair because of severe mitral regurgitation as a result of P2 prolapse was treated with insertion of neochords and a 36 Carpentier-Edwards physio-ring. After weaning from cardiopulmonary bypass, S-T elevation in leads II, III, and aVF occurred. On transesophageal echocardiography an occlusion or distortion of the circumflex artery by ring sutures was suggested, because coronary flow was no longer detected by color Doppler. Despite stable hemodynamics an angiogram was performed, which confirmed the diagnosis of stenosis of the circumflex artery. During reoperation 4 sutures placed at the P1 segment of the mitral valve annuloplasty were corrected. Transesophageal echocardiography could detect a good flow of the circumflex artery and the electrocardiographic changes disappeared.

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Research paper thumbnail of Transapical Aortic Valve Implantation

Journal of the American College of Cardiology, 2012

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Research paper thumbnail of Transcatheter Aortic Valve Implantation: Is General Anesthesia Superior to Conscious Sedation?

Journal of Cardiothoracic and Vascular Anesthesia, 2011

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Research paper thumbnail of Anesthesia Management for Transapical Transcatheter Aortic Valve Implantation: A Case Series

Journal of Cardiothoracic and Vascular Anesthesia, 2009

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Research paper thumbnail of The Incidence of Intraoperative Awareness in Cardiac Surgery Fast-track Treatment

Journal of Cardiothoracic and Vascular Anesthesia, 2010

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Research paper thumbnail of Transcatheter Aortic Valve Replacement—Part 3: The Central Role of Perioperative Transesophageal Echocardiography

Journal of Cardiothoracic and Vascular Anesthesia, 2012

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Research paper thumbnail of Transfusion of Allogeneic Blood Products in Proximal Aortic Surgery With Hypothermic Circulatory Arrest: Effect of Thromboelastometry-Guided Transfusion Management

Journal of Cardiothoracic and Vascular Anesthesia, 2013

Proximal aortic surgery with hypothermic circulatory arrest (HCA) commonly involves perioperative... more Proximal aortic surgery with hypothermic circulatory arrest (HCA) commonly involves perioperative transfusion of allogeneic blood products, including red blood cells, plasma, and platelets. The authors hypothesized that surgery with HCA could be performed without allogeneic blood products and that a thromboelastometry-guided algorithm would reduce the transfusion of allogeneic blood products. A retrospective analysis of prospectively collected data. Patients with and without thromboelastometry guidance were compared by case-control analysis (n = 62 matched patients) and multivariate regression (n = 194 patients). Single-center university hospital. This study included 194 patients undergoing elective and emergent procedures with HCA involving the proximal aorta. A thromboelastometry-guided treatment algorithm during surgery was used in 153 patients (79%), and conventional coagulation management was used in 41 patients (21%). During surgery and the following 24 hours, allogeneic blood products were transfused in 106 patients (55%). Median (interquartile range) number of allogeneic blood products transfused was 1 unit (0-6 units). Case-control analysis showed lower transfusion rates of red blood cells, plasma, and any allogeneic blood product (all p<0.050) in patients with thromboelastometry guidance. In the multivariate analysis, thromboelastometry guidance was associated with an odds ratio of 0.26 (95% confidence interval, 0.08-0.84; p = 0.025) for the transfusion of any allogeneic blood product. The use of thromboelastometry was not associated with adverse events (odds ratio 0.72; 95% confidence interval, 0.27-1.90; p = 0.507). Allogeneic blood products were avoided in a proportion of patients. The findings further suggest that thromboelastometry-guided coagulation management promoting the use of coagulation factor concentrates decreased the use of allogeneic blood products during complex cardiac surgery.

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