Objective Thromboelastography (TEG) measures the dynamics of clot formation in whole blood and provides data that can guide specific blood component therapy. This study analyzed whether the implementation of TEG affected blood product utilization and overall hemostasis in infants (6 months and younger) undergoing open heart surgery. Methods TEG values measured include R (time to fibrin formation), angle (fibrinogen formation), and MA (platelet function). Blood product usage, TEG values, and operative parameters were collected during surgery on 112 consecutive infants (66 acyanotic) undergoing open heart surgery within the first 6 months of life. Controls consisted of chart data on 70 consecutive patients (57 acyanotic) undergoing the same surgical procedures before implementation of TEG (pre-TEG). Results Using TEG, the pattern of blood product utilization changed. Compared with the pre-TEG era, TEG era patients demonstrated a significant increase in fresh frozen plasma usage intraoperatively (4.74 vs. 1.83 mL/kg; P < 0.001) and reduced postoperative use of platelets (1.69 vs. 3.74 mL/kg; P = 0.006) and cryoprecipitate (0.89 vs. 1.95 mL/kg; P = 0.149). Chest tube drainage was significantly reduced at 1, 2, and 24 hours in the TEG group. TEG angle and MA measurements suggest that fibrinogen and platelets of cyanotic patients are more sensitive to hemodilution than the acyanotic patients. Conclusions TEG allows for proactive, goal-directed blood component therapy with improved postoperative hemostasis in infants undergoing cardiopulmonary bypass.
percent underwent horizontal AMZ with an average anteriorization of 10.7mm and medialization of 13.4mm. Ninety-four percent (16/17) were satisfied and would reopt for surgery. Eighty two percent reported being active at last follow-up. Nearly half engaged in moderate to high intensity sports. Thirty-five percent engaged in recreational activities while 18% were minimally active. Four of sixteen reported substantial activity-related pain at last follow-up (all grade III arthrosis at surgery). The average pain score [range 0-10] for the remaining 75% was 2.1 (p<0.001); and the majority of these patients demonstrated grade I-II arthrosis. Post-AMZ symptomatic medial patellar subluxation was corrected successfully in two patients. Fifty-nine percent underwent removal of hardware and 41% required additional procedures. There were no cases of post-op PF instability or conversion to knee arthroplasty. Conclusion: AMZ is effective in ameliorating symptoms and facilitating active lifestyles 15-20 years out in select young patients with lateral or distal PF arthrosis. Ninetyfour percent were satisfied and would choose the procedure again.
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