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Title: Haemostatic management for aortic valve replacement in a patient with advanced liver disease.
Austin 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
Publication information: 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.
Gov't Doc #: 25325074
DOI: 10.12998/wjcc.v2.i10.596
Type: Journal Article
Subjects: Cardiac surgery
Cardiopulmonary bypass
Liver failure
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