Hypothermic circulatory arrest induced coagulopathy: rotational thromboelastometry analysis

Abstract

Objectives Hypothermic circulatory arrest (HCA) has been considered to cause coagulopathy during cardiac surgery. However, coagulopathy associated with HCA has not been understood clearly in details. The objective of this study is to analyze the details of coagulopathy related to HCA in cardiac surgery by using rotational thromboelastometry (ROTEM). Methods We retrospectively analyzed 38 patients who underwent elective cardiac surgery (HCA group = 12, non-HCA group = 26) in our hospital. Blood samples were collected before and after cardiopulmonary bypass (CPB). Standard laboratory tests (SLTs) and ROTEM were performed. We performed four ROTEM assays (EXTEM, INTEM, HEPTEM and FIBTEM) and analyzed the following ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF) and maximum clot elasticity (MCE). The amount of perioperative bleeding, intraoperative transfusion and perioperative data were compared between the HCA and non-HCA group. Results Operation time and hemostatic time were significantly longer in the HCA group, whereas CPB time had no difference between the groups. The amount of perioperative bleeding and intraoperative transfusion were much higher in the HCA group. SLTs showed no difference between the groups both after anesthesia induction and after protamine reversal. In ROTEM analysis, MCE contributed by platelet was reduced in the HCA group, whereas MCE contributed by fibrinogen had no difference. Conclusion Our study confirmed that the amount of perioperative bleeding and intraoperative transfusion were significantly higher in the HCA group. ROTEM analysis would indicate that clot firmness contributed by platelet component is reduced by HCA in cardiac surgery.

The David Operation Offers Shorter Hemostasis Time Than the Bentall in Case of Acute Aortic Dissection Type A

“…In general, aortic root surgery is more common in western countries, and aortic arch surgery is more common in Japan. Regarding aortic root surgery in patients with AADA, the frequency of root replacement was about 30% in Europe and the United States [ 10 ], whereas it is obviously low, at about 7%, in Japan [ 11 ]. On the other hand, the frequency of total arch replacement was about 15% in Europe and the United States and about 56% in Japan [ 10 , 11 ].…”

“…Regarding aortic root surgery in patients with AADA, the frequency of root replacement was about 30% in Europe and the United States [ 10 ], whereas it is obviously low, at about 7%, in Japan [ 11 ]. On the other hand, the frequency of total arch replacement was about 15% in Europe and the United States and about 56% in Japan [ 10 , 11 ]. Our study's frequency of total arch replacement is less than 30% in both groups.…”

Surgical Treatment of an Innominate Artery Aneurysm Using Near-Infrared Spectroscopy for Cerebral Monitoring: A Case Report

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“…However, hypothermic circulatory arrest makes the postoperative course challenging because of coagulopathy and the prolonged need for ventilator support [ 5 , 6 ]. Moreover, arrhythmia after hypothermic circulatory arrest is associated with considerable morbidity and mortality [ 5 - 7 ]. NIRS is now a widespread cerebral monitoring method used during carotid surgery.…”

Manejo intraoperatório do sangramento em cirurgias de grande porte com métodos viscoelástico

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