Aprotinin and tranexamic acid have similar hemostatic effectiveness in high-transfusion-risk cardiac surgery. Within the confines of propensity score matching, our results suggest that aprotinin may be associated with renal dysfunction.

Purpose: Recombinant factor VIIa (rFVIIa) is being used for refractory, excessive blood loss (EBL) after cardiac surgery, but its safety for this indication is not known. Methods:The unadjusted and risk-adjusted adverse event (AE) rates were compared between 114 consecutive cardiac surgical patients who received rFVIIa for refractory EBL and 541 concurrent patients who developed EBL but did not receive rFVIIa. Similarly, timing of rFVIIa therapy was assessed by dichotomizing rFVIIa patients based on median number of red blood cell (RBC) units received before therapy. The measured AE was a composite of death, stroke, renal failure, myocardial infarction, and major vein thrombosis. For risk adjustment, logistic regression models for this outcome were constructed using known predictors of AEs. Results:The median RBC units transfused before rFVIIa therapy was eight. The AE rates in the untreated, early (≤ 8 U), and late (> 8 U) treated patients were 24% (129/541), 30% (20/66), and 60% (29/48). The risk-adjustment model included total RBC units, pump time, weaning difficulty, gender, weight, and age. The unadjusted and adjusted AE odds ratios (OR) in the treated vs untreated groups were 2.41 [confidence interval (CI) 1.58 -3.67; P < 0.0001] and 1.04 (CI 0.60 -1.81; P = 0.9). In the rFVIIa group, the adjusted AE OR was lower in the early treated group (OR 0.41; CI 0.18 -0.92; P = 0.03). Conclusion:In cardiac surgical patients with refractory hemorrhage, rFVIIa therapy is not associated with increased risk of AEs, and early treatment may be associated with better outcomes. 24 % (129/541), 30 % (20/66) et 60 % (29/48 de 1,67 ; P < 0,0001] et 1,04 (IC 0,81 ; P = 0,9). Dans le groupe rFVIIa, le RR d'EI ajusté a été plus bas chez les patients traités tôt (RR 0,41 ; IC 0,92 ; P = 0,03 Objectif : Le facteur VIIa recombinant (rFVIIa) est utilisé pour traiter les pertes sanguines excessives (PSE) réfractaires après une opération cardiaque sans qu'on en connaisse l'innocuité. Méthode : Les taux d'événements indésirables (EI) non ajustés et ajustés en fonction des risques ont été comparés entre 114 patients consécutifs de cardiochirurgie ayant reçu le rFVIIa pour des PSE et 541 patients consécutifs qui ont eu des PSE mais pas de rFVIIa. De même, la programmation du traitement au rFVIIa a été étudiée par une division dichotomique des patients, recevant le rFVIIa, fondée sur le nombre médian d'unités de culots globulaires (CG) reçues avant le traitement. Les EI étaient la mort, l'accident vasculaire, l'insuffisance rénale, l'infarctus du myocarde et la thrombose veineuse majeure. Des modèles de régression logistique ont été construits pour ajuster le risque en utilisant les prédicteurs connus d'EI. Résultats : La médiane des unités de CG transfusées avant le traitement au rFVIIa a été de huit. Les taux d'EI chez les patients non traités, traités tôt (≤ 8 U) et tard (> 8 U) ont été de

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Budd-Chiari syndrome (BCS) is a congestive hepatopathy caused by hepatic venous outflow obstruction. Torsion of the remnant liver after extended right hepatectomy is a potential cause of acute BCS, and it can lead to acute liver failure or death. We present a case of intraoperative transesophageal echocardiographic (TEE) diagnosis of acute BCS after extended right hepatectomy. TEE allowed timely detection of acute BCS and consequent inferior vena cava obstruction and decreased right atrial filling as the cause of sudden life-threatening hemodynamic collapse unresponsive to intravascular volume therapy and inotropic support. TEE constituted a stepped-up level of monitoring, prompting an immediate surgical reexploration, and resolution of hemodynamic instability.