Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/12432
Title: Haemostatic management for aortic valve replacement in a patient with advanced liver disease.
Authors: Weinberg, Laurence;Kearsey, Irene;Tjoakarfa, Clarissa;Matalanis, George;Galvin, Sean;Carson, Scott;Bellomo, Rinaldo;McNicol, Larry;McCall, Peter R
Affiliation: Laurence Weinberg, Irene Kearsey, Clarissa Tjoakarfa, Larry McNicol, Peter McCall, Department of Anaesthesia, Austin Hospital, Melbourne, Victoria 3084, Australia.
Issue Date: 16-Oct-2014
Citation: World Journal of Clinical Cases; 2(10): 596-603
Abstract: Redo-sternotomy and aortic valve replacement in patients with advanced liver disease is rare and associated with a prohibitive morbidity and mortality. Refractory coagulopathy is common and a consequence of intense activation of the coagulation system that can be triggered by contact of blood with the cardiopulmonary bypass circuitry, bypass-induced fibrinolysis, platelet activation and dysfunction, haemodilution, surgical trauma, hepatic decompensation and hypothermia. Management can be further complicated by right heart dysfunction, porto-pulmonary hypertension, poor myocardial protection, and hepato-renal syndrome. Complex interactions between coagulation/fibrinolysis and systemic inflammatory response syndrome reactions like "post-perfusion-syndrome" also compound haemostatic failure. Given the limited information available for the specific management and prevention of cardiopulmonary bypass-induced haemostatic failure, this report serves to guide the anaesthesia and medical management of future cases of a similar kind. We discuss our multimodal management of haemostatic failure using pharmacological strategies, thromboelastography, continuous cerebral and liver oximetry, and continuous cardiac output monitoring.
Internal ID Number: 25325074
URI: http://ahro.austin.org.au/austinjspui/handle/1/12432
DOI: 10.12998/wjcc.v2.i10.596
URL: http://www.ncbi.nlm.nih.gov/pubmed/25325074
Type: Journal Article
Subjects: Cardiac surgery
Cardiopulmonary bypass
Coagulopathy
Liver failure
Appears in Collections:Journal articles

Files in This Item:
There are no files associated with this item.


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.