ROTEM disagreed with SCTs and did not show the temporary hypocoagulability suggested by SCTs. Both ROTEM and SCTs showed no signs of hypercoagulability. Future studies involving ROTEM could help develop new guidelines for coagulation monitoring.
Objectives: Newer generations of stented pericardial valves may
offer hemodynamic benefit in patients with small aortic annulus. The aim
of this study was to determine the effectiveness of isolated aortic
valve replacement with one such valve, the Trifecta valve, when compared
to Aortic root enlargement surgery in reducing postoperative gradients
and the severity of PPM in patients with small aortic annulus.
Patients and methods: A prospective observational study of 100
patients with SAA who underwent AVR from March 2020 to October 2021 in
Cairo university hospitals and other centers. The cohort was divided
into two groups based on surgical technique: Isolated AVR using Trifecta
valve or ARE and mechanical valve placement. Preoperative
characteristics, intraoperative times and postoperative outcomes were
recorded and compared in all patients, including a pre-discharge
echocardiography. Results: Increased operative times, increased
ICU stay and need for blood products were observed in the ARE group and
operative time was determined as an independent risk factor. Higher rate
of complications such as need for permanent pacemaker as well increased
postoperative drainage was also recorded in ARE group, with no
difference between groups in in-hospital mortality. Higher incidence of
PPM was recorded in the Trifecta group (24%) compared to the ARE group
(8%). but, the severity of PPM within the Trifecta group was reduced
compared to the ARE group, and no degree of PPM was observed in Trifecta
valves sized 21. Conclusion The Trifecta valve offers excellent
postoperative hemodynamics and significant reduction in severity of PPM
in patients with SAA undergoing AVR, with gradients and iEOA almost
comparable to larger sized valves implanted after ARE, making the
increased surgical burden of ARE unnecessary in most patients.
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