1
|
Vandenheuvel M, Vandewiele K, De Somer F, Wouters PF. Protamine dosing in cardiac surgery. Perfusion 2024; 39:645-646. [PMID: 36696481 DOI: 10.1177/02676591231154116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
| | | | - Filip De Somer
- Department of Perfusion, University Hospital Ghent, Ghent, Belgium
| | - Patrick F Wouters
- Department of Anaesthesia, University Hospital Ghent, Ghent, Belgium
| |
Collapse
|
2
|
Zwaenepoel B, Vandewiele K, Peperstraete H, De Ryck F, Vanpeteghem C, Malfait T, Herck I, Vandenberghe W, Van Laethem L, Defreyne L, Van Braeckel E, Depuydt P, Schaubroeck H. Video-assisted thoracic surgery in critically ill COVID-19 patients on venovenous extracorporeal membrane oxygenation. Perfusion 2023; 38:1577-1583. [PMID: 35969115 PMCID: PMC9379594 DOI: 10.1177/02676591221119319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) leads to thoracic complications requiring surgery. This is challenging, particularly in patients supported with venovenous extracorporeal membrane oxygenation (VV-ECMO) due to the need for continuous therapeutic anticoagulation. We aim to share our experience regarding the safety and perioperative management of video-assisted thoracic surgery for this specific population. METHODS Retrospective, single-center study between November 2020 and January 2022 at the ICU department of a 1.061-bed tertiary care and VV-ECMO referral center during the COVID-19 pandemic. RESULTS 48 COVID-19 patients were supported with VV-ECMO. A total of 14 video-assisted thoracic surgery (VATS) procedures were performed in seven patients. Indications were mostly hemothorax (85.7%). In eight procedures heparin was stopped at least 1 h before incision. A total of 10 circuit changes due to clot formation or oxygen transfer failure were required in six patients (85.7%). One circuit replacement seemed related to the preceding VATS procedure, although polytransfusion might be a contributing factor. None of the mechanical complications was fatal. Four VATS-patients (57.1%) died, of which two (50%) immediately perioperatively due to uncontrollable bleeding. All three survivors were treated with additional transarterial embolization. CONCLUSION (1) Thoracic complications in COVID-19 patients on VV-ECMO are common. (2) Indication for VATS is mostly hemothorax (3) Perioperative mortality is high, mostly due to uncontrollable bleeding. (4) Preoperative withdrawal of anticoagulation is not directly related to a higher rate of ECMO circuit-related complications, but a prolonged duration of VV-ECMO support and polytransfusion might be. (5) Additional transarterial embolization to control postoperative bleeding may further improve outcomes.
Collapse
Affiliation(s)
- Bert Zwaenepoel
- Department of Cardiology, Ghent
University Hospital, Ghent University, Ghent, Belgium
| | - Korneel Vandewiele
- Department of Perfusion, Ghent
University Hospital, Ghent University, Ghent, Belgium
| | - Harlinde Peperstraete
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Frederic De Ryck
- Department of Thoracic and Vascular
Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Caroline Vanpeteghem
- Department of Anesthesiology, Ghent
University Hospital, Ghent University, Ghent, Belgium
| | - Thomas Malfait
- Department of Respiratory Medicine,
Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ingrid Herck
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Wim Vandenberghe
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Lien Van Laethem
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Luc Defreyne
- Department of Interventional
Radiology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Eva Van Braeckel
- Department of Respiratory Medicine,
Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Internal Medicine and
Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Pieter Depuydt
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Internal Medicine and
Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hannah Schaubroeck
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| |
Collapse
|
3
|
Vandenheuvel M, VAN Gompel C, Vandewiele K, DE Kesel PM, Wyffels P, DE Somer F, Devreese KM, Wouters PF. Comparison of coagulation monitoring using ROTEM and Sonoclot devices in cardiac surgery. A single-centre prospective observational study. Minerva Anestesiol 2022; 88:680-689. [PMID: 35315620 DOI: 10.23736/s0375-9393.22.16119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Viscoelastic tests (VETs) are recommended during cardiac surgery to monitor coagulation status and guide transfusion. We compared the results of two VETs, the Sonoclot Analyzer and the ROTEM Sigma. Agreement between viscoelastic tests' subdiagnoses and overall diagnosis severity was assessed. Correlations with conventional coagulation tests (CCT) and the discriminatory potential of numerical VET outputs for transfusion thresholds was determined. METHODS Single-centre, prospective observational study in a tertiary academic centre. In fifty adult patients undergoing elective cardiac surgery, parallel Sonoclot, ROTEM and CCT analysis was performed before heparin, or after protamine or coagulation product administration. All patients completed the study, resulting in 139 data points. RESULTS Agreement on the severity of coagulation disorders was acceptable (83%), but poor (27%) on the differentiation of the underlying causes. Correlations between ROTEM parameters and CCT were good (post-protamine: FIBTEM A5 (r2 = 0.90 vs fibrinogen) and EXTEM-FIBTEM A5 difference (r2 = 0.81 vs platelet count) ). Sonoclot correlated less (Clot Rate (r2 = 0.25 vs fibrinogen) and Platelet Function (r2 = 0.43 vs platelet count)). This was reflected in the discriminatory potential of these parameters as found by linear mixed modelling. We suggest clinically useful grey zones for VET cutoff interpretation. CONCLUSIONS ROTEM and Sonoclot accord well on the detection of severity of coagulation dysfunction, but not on the diagnosis of the underlying cause. ROTEM correlated more closely with CCT then Sonoclot. We propose a testing strategy that could lead to a cost-effective approach to the bleeding cardiac surgery patient.
Collapse
Affiliation(s)
| | - Carla VAN Gompel
- Department of Anaesthesia, University Hospital Ghent, Ghent, Belgium
| | | | - Pieter M DE Kesel
- Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Piet Wyffels
- Department of Anaesthesia, University Hospital Ghent, Ghent, Belgium
| | - Filip DE Somer
- Department of Perfusion, University Hospital Ghent, Ghent, Belgium
| | - Katrien M Devreese
- Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium.,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Patrick F Wouters
- Department of Anaesthesia, University Hospital Ghent, Ghent, Belgium
| |
Collapse
|
4
|
Missault S, Causenbroeck JV, Vandewiele K, Czapla J, Philipsen T, François K, Bové T. Analysis of clinical outcome and postoperative organ function effects in a propensity‐matched comparison between conventional and minimally invasive mitral valve surgery. J Card Surg 2020; 35:3276-3285. [DOI: 10.1111/jocs.15010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sophie Missault
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| | | | | | - Jens Czapla
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| | - Tine Philipsen
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| | - Katrien François
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| | - Thierry Bové
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| |
Collapse
|
5
|
Vandewiele K, De Somer F, Vandenheuvel M, Philipsen T, Bové T. The impact of cardiopulmonary bypass management on outcome: a propensity matched comparison between minimally invasive and conventional valve surgery. Interact Cardiovasc Thorac Surg 2020; 31:48-55. [DOI: 10.1093/icvts/ivaa052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Research concerning cardiopulmonary bypass (CPB) management during minimally invasive cardiac surgery (MICS) is scarce. We investigated the effect of CPB parameters such as pump flow, haemoglobin concentration and oxygen delivery on clinical outcome and renal function in a propensity matched comparison between MICS and median sternotomy (MS) for atrioventricular valve surgery.
METHODS
A total of 356 patients undergoing MICS or MS for atrioventricular valve surgery between 2006 and 2017 were analysed retrospectively. Propensity score analysis matched 90 patients in the MS group with 143 in the MICS group. Logistic regression analysis was performed to investigate independent predictors of cardiac surgery-associated acute kidney injury in patients having MICS.
RESULTS
In MICS, CPB (142.9 ± 39.4 vs 101.0 ± 38.3 min; P < 0.001) and aortic cross-clamp duration (89.9 ± 30.6 vs 63.5 ± 23.0 min; P < 0.001) were significantly prolonged although no differences in clinical outcomes were detected. The pump flow index was lower [2.2 ± 0.2 vs 2.4 ± 0.1 l⋅(min⋅m2)−1; P < 0.001] whereas intraoperative haemoglobin levels were higher (9.25 ± 1.1 vs 8.8 ± 1.2; P = 0.004) and the nadir oxygen delivery was lower [260.8 ± 43.5 vs 273.7 ± 43.7 ml⋅(min⋅m2)−1; P = 0.029] during MICS. Regression analysis revealed that the nadir haemoglobin concentration during CPB was the sole independent predictor of cardiac surgery-associated acute kidney injury (odds ratio 0.67, 95% confidence interval 0.46–0.96; P = 0.029) in MICS but not in MS.
CONCLUSIONS
Specific cannulation-related issues lead to CPB management during MICS being confronted with flow restrictions because an average pump flow index ≤2.2 l/min/m2 is achieved in 40% of patients who have MICS compared to those who have a conventional MS. This study showed that increasing the haemoglobin level might be helpful to reduce the incidence of cardiac surgery-associated acute kidney injury after minimally invasive mitral valve surgery.
Collapse
Affiliation(s)
| | - Filip De Somer
- Department of Perfusion, University Hospital Ghent, Ghent, Belgium
| | | | - Tine Philipsen
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Thierry Bové
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| |
Collapse
|
6
|
Vandewiele K, Thierry B. eReply. Is retrograde autologous priming effective on cerebral functions and haematocrit levels? Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
7
|
Vandewiele K, Bové T, De Somer FMJJ, Dujardin D, Vanackere M, De Smet D, Moerman AT, Bouchez S, François K. The effect of retrograde autologous priming volume on haemodilution and transfusion requirements during cardiac surgery. Interact Cardiovasc Thorac Surg 2013; 16:778-83. [PMID: 23482374 DOI: 10.1093/icvts/ivt085] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Many cardiac procedures using cardiopulmonary bypass (CPB) still require intraoperative transfusion. Retrograde autologous priming (RAP) has been introduced to decrease haemodilution and the blood transfusion rate. This study is designed to determine the influence or RAP on intraoperative haematocrit, transfusion and its clinical consequences. METHODS The RAP effect was retrospectively studied in 753 patients during contemporary cardiac surgery, targeting a haematocrit of 25%. Multivariate linear regression analysis was performed to identify the independent factors influencing intraoperative haematocrit, transfusion rate and transfusion quantity. RESULTS RAP was used in 498 patients and compared with 255 controls. RAP decreased the haemodilution level (nadir haematocrit 26.8 standard deviation [SD] 4.0% in RAP vs 25.8 SD 3.6% in controls; P = 0.001) and transfusion frequency (26.1 vs 33.3%, P = 0.04), despite smaller patients (body surface area [BSA] 1.86 SD 0.20 m(2) vs 1.91 SD 0.21 m(2) in RAP vs controls; P = 0.002) with lower preoperative haematocrit (38.9 SD 4.4% vs 40.5 SD 4.6%; P < 0.001). Optimal RAP volume was overall 475 ml (ROC area 0.55; 95% confidence interval [CI] 0.50-0.60; P = 0.04) and 375 ml in patients with BSA <1.7 m(2) (ROC area 0.63; 95% CI 0.54-0.73; P = 0.008) to decrease the transfusion incidence. Multivariate analysis revealed RAP volume as a significant determinant of nadir haematocrit (β = 0.003, 95% CI 0.002-0.004, P < 0.001) and transfusion rate (odds ratio (OR) = 0.997, 95% CI 0.996-0.999, P < 0.001), independent of BSA, gender and preoperative haematocrit. CONCLUSIONS Retrograde autologous priming is an effective adjunct to decrease the blood transfusion rate, coping with the CPB-related haemodilution and its adverse clinical effects. A RAP volume individualized to each patient offers most benefit as part of a multidisciplinary blood conservation approach.
Collapse
Affiliation(s)
- Korneel Vandewiele
- Department of Perfusion, Heart Centre, University Hospital of Ghent, Ghent, Belgium.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Vlasselaers D, Vandewiele K, Van Herpe T, De Moor B, Van den Berghe G. Implementing tight glycaemic control: performance of bedside glucometers. Crit Care 2007. [PMCID: PMC4095195 DOI: 10.1186/cc5301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
|