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Cardiopulmonary bypass (CPB) coagulopathy increases utilization of allogenic blood/blood products, which can negatively affect patient outcomes. Thromboelastography (TEG) is a point-of-care measurement of clot formation and fibrinolysis. We investigated whether the addition of TEG parameters to a clinically based bleeding model would improve the predictability of postoperative bleeding. A total of 439 patients’ charts were retrospectively investigated for 8-h chest tube output (CTO) postoperatively. For model 1, the variables recorded were patient age, gender, body surface area, clopidogrel use, CPB time, first post-CPB fibrinogen serum level, first post-CPB platelet count, first post-CPB international normalized ratio, the total amount of intraoperative cell saver blood transfused, and postoperative first ICU hematocrit level. Model 2 had the model 1 variables, TEG angle, and maximum amplitude. The outcome was defined as 0–8-h CTO. The predictor variables were placed into a forward stepwise regression model for continuous outcomes. Analysis of variance with adjusted R2 was used to assess the goodness-of-fit of both predictive models. The predictive accuracy of the model was examined using CTO as a dichotomous variable (75th percentile, 480 ml) and receiver operating characteristic curves for both models. Advanced age, male gender, preoperative clopidogrel use for 5 days or less, greater cell saver blood utilization, and lower postoperative hematocrit levels were associated with increased 8-h CTO (P < 0.05). Adding TEG angle and maximum amplitude to model 1 did not improve CTO predictability. When TEG angle and maximum amplitude were added as predictor factors, the predictability of the bleeding model did not improve.

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Objective: To describe thoroughly and quantitatively the morphologic features of the human tricuspid valve, to define and classify certain prominent normal variations, and to offer a clear and concise terminology for describing its morphology. Background. In recent years there has been growing interest in the tricuspid valve. Noninvasive imaging is now commonplace and remarkably detailed. Surgical interventions involving the tricuspid valve have become increasingly common. These factors underscore the need for a detailed understanding of the anatomy of the tricuspid valve and of its normal variations. Methods. Quantitative and anatomic features of the tricuspid valve were studied in 24 normal hearts at autopsy from subjects evenly distributed by age and sex. Leaflet length, surface area, chordal number, and leaflet morphology were recorded. Results. Valves demonstrated some degree of leaflet subdivision in 92% of cases. Mean tricuspid valve length was 11.3 * 0.1 cm and the surface area was 21.0 ? 1.1 cm'. Mean lengths and surface areas were similar for the anterior, posterior, and septal leaflets (38-42 mm and 5.9-7.8 cm2, respectively). However, for a given valve, the longest leaflet could be twice the length and three times the area of the smallest. Calculated valvular diameter was 2.13 * 0.03 cm/m2. The tricuspid valve was served by an average of 170 2 36 chordae tendineae, 49% inserted on the free edge of the valve, 44% on the undersurface, and 7% on the basal regions. Chordal density (number of chordaekm') was greater in women than men (9.9 2 0.5 vs. 7.3 ? 0.7 chordaekm', P < 0.02). The septal leaflet had the greatest chordal density and the anterior leaflet the lowest (12.7 2 0.9 vs. 5.9 ? 0.5 chordae/cmz). Conclusions. The concept of chordal density for the tricuspid valve has not been previously described and may be clinically relevant in the pathogenesis of valvular prolapse. Modifications of existing tricuspid valve nomenclature are suggested.