Haemodilution tolerance in patients with mitral regurgitation

Spahn, Donat R.; Seifert, Burkhardt; Pasch, Thomas; Schmid, Edith R.

doi:10.1111/j.1365-2044.1998.00272.x

Cited by 37 publications

(9 citation statements)

References 11 publications

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“…Narkotisierte Patienten mit Mitralinsuffizienz und Vorhofflimmern tolerierten eine Hämodilution auf Hb 10,3±0,4 g/dl (6,39±0,25 mmol/l) problemlos [98]. Bei narkotisierten Patienten mit hochgradiger Aortenstenose (KÖF 0,6±0,1 cm 2 ) waren die kardialen Kompensationsmechanismen der Anämie bei Hb 9,1±0,9 g/dl (5,65±0,56 mmol/l) erschöpft [58].…”

Section: Myokardperfusion Und -Funktionunclassified

Perioperative Anämietoleranz

Häbler

Meier²,

Pape³

et al. 2006

Anaesthesist

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The expected cost explosion in transfusion medicine (increasing imbalance between donors and potential recipients, treatment of transfusion-associated complications) increases the socio-economic significance of specific institutional transfusion programs. In this context the estimated use of the patient's physiologic tolerance to anemia enables 1) the tolerance of larger blood losses (loss of "diluted blood"), 2) the onset of transfusion to the time after surgical control of bleeding to be delayed and 3) the perioperative collection of autologous red blood cells. The present review article summarizes the mechanisms, influencing factors and limits of this natural tolerance to anemia and deduces the indication for perioperative red blood cell transfusion. Under strictly controlled conditions (anesthesia, normovolemia, complete muscular relaxation, hyperoxemia, mild hypothermia) extremely low hemoglobin concentrations [Hb <3 g/dl (<1.86 mmol/l)] are tolerated without transfusion by individuals with no cardiopulmonary disease. In the clinical routine these situations are limited to borderline situations e.g. unexpected massive blood losses in Jehovah's Witnesses or unexpected shortcomings in blood supply. The current recommendations coincide to the effect that perioperative red blood cell transfusion 1) is unnecessary up to a Hb concentration of 10 g/dl (6.21 mmol/l) even in older patients with cardiopulmonary comorbidity and 2) is only recommended in cases of Hb <6 g/dl (<3.72 mmol/l) in otherwise healthy subjects including pregnant women and children. Critically ill patients with multiple trauma and sepsis do not seem to benefit from transfusions up to Hb concentrations >9 g/dl (>5.59 mmol/l). In cases of massive hemorrhaging and diffuse bleeding disorders the maintenance of a Hb concentration of 10 g/dl (6.21 mmol/l) seems to contribute to stabilization of coagulation.

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Section: Myokardperfusion Und -Funktionunclassified

Perioperative Anämietoleranz

Häbler

Meier²,

Pape³

et al. 2006

Anaesthesist

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“…Patients with mitral valve insufficiency showed a good tolerance to hemodilution to hemoglobin levels of 10 g/dL, even in case of the loss of atrial contraction due to atrial fibrillation (42).…”

Section: Heartmentioning

confidence: 99%

Anemia and perioperative red blood cell transfusion: A matter of tolerance

Madjdpour

Spahn

Weiskopf

2006

Critical Care Medicine

108

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In the past, anemia in the perioperative period has been treated by red blood cell (RBC) transfusions relatively uncritically. RBC transfusions were believed to increase oxygen delivery by increasing hemoglobin concentration. Arbitrary transfusion triggers such as the "10/30 rule" (i.e., RBC transfusion indicated below a hemoglobin concentration of 10 g/dL or a hematocrit of 30%) were applied. However, there is now increasing evidence that RBC transfusions are associated with adverse outcomes and should be avoided whenever possible. Restraining from RBC transfusions and maintaining normovolemia in patients suffering from surgical blood loss results in acute anemia. Therefore, knowing the compensatory mechanisms during acute anemia is crucial. This review focuses on acute anemia tolerance, its limits, and physiologic transfusion triggers in the perioperative period.

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“…13 Aortic stenosis and heart failure can interfere with anemia compensatory mechanisms as well, but patients with mitral valve insufficiency usually tolerate anemia well. 14 It has been suggested that the main compensatory mechanism in response to normovolemic hemodilution in elderly patients is increased oxygen extraction and raised arterial oxygen tension as opposed to solely increased CO. Thus, decreasing Hb can reduce DO 2 to organs significantly.…”

Section: S38mentioning

confidence: 99%

Sirolimus-Loaded Polyurethane Graft for Hemodialysis Access in Sheep

Shander

2008

Vascular

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Intimal hyperplasia is the most common final pathway for hemoaccess occlusion in dialysis patients. Drug eluting stents have been shown to decrease intimal hyperplasia in coronary arteries and possibly in peripheral arteries. We evaluated the use of a sirolimus loaded polyurethane graft as prophylaxis in hemodialysis access. Grafts were loaded with sirolimus and elution curves were determined for the polyurethane material. The arteriovenous grafts were then placed in the neck of 20 sheep. A non-loaded graft was placed in the contralateral neck. Patency rates, ultrasound evaluation, angiography and histomorphometry were determined for each graft. At 30, 60 and 90 days the drug loaded graft had improved patency rates compared to the control, with a 25% improvement noted at 3 months. Life table analysis showed the drug loaded graft consistently better patency than the control (p=.136). The control graft had greater neointimal stenosis (14.5% vs. 9.17%) over the course of the study (p=.157). Although none of these findings was statistically significant in this pilot study, the sirolimus coated graft out-performed the control in every measured parameter at each time point evaluated. Further work to asses the validity of drug coated materials to prevent intimal hyperplasia in hemodialysis access is warranted.

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Haemodilution tolerance in patients with mitral regurgitation

Cited by 37 publications

References 11 publications

Perioperative Anämietoleranz

Perioperative Anämietoleranz

Anemia and perioperative red blood cell transfusion: A matter of tolerance

Sirolimus-Loaded Polyurethane Graft for Hemodialysis Access in Sheep

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