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Markus Gerigk - One of the best experts on this subject based on the ideXlab platform.
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clinical advantages of using mini bypass systems in terms of Blood Product use postoperative bleeding and air entrainment an in vivo clinical perspective
European Journal of Cardio-Thoracic Surgery, 2007Co-Authors: Matthias Perthel, Andreas Bendisch, Joachim Laas, Lemir Elayoubi, Markus GerigkAbstract:Objective: In an effort to minimize the effect of extracorporeal circulation (ECC), mini-bypass is gaining clinical acceptance in routine coronary artery bypass grafting (CABG). These small circuits target combine the clinical advantages of reduced prime, 100% bio-coating and suction Blood separation. We demonstrate that the use of mini-bypass in routine CABG reduces homologous Blood Product use and postoperative bleeding. Our goal was to also demonstrate that these small systems are effective in gaseous microemboli (GME) management as compared to a conventional extracorporeal system. Methods: Prospective, randomized study comparing 30 mini-bypass (Dideco ECC.O TM ) to 30 conventional systems (n = 30, Dideco 903 Avant TM ). Study included CABG cases only, independent of preoperative coagulative status; clinic ethical committee approval and informed patient consent was obtained before initiating study. Results: There were no statistical differences in terms of patient demographics. Statistically significant differences were seen in transfusion frequency (27% of the study group vs 43% in the control group, p = 0.05), transfused volume (133.3 244.5 ml vs 325 483.1 ml, p < 0.05), fresh frozen plasma (0 unit vs 3 units, p < 0.001), postoperative bleeding (301.8 531.9 ml vs 785.5 1000.4 ml, p < 0.05) and GME activity post-arterial filter (0.14 ml vs 5.32 ml, p < 0.05). Conclusions: The adoption of mini-bypass significantly potentially reduces hemodilution, donor Blood usage, postoperative bleeding and exposure to GME in routine CABG patients as compared to the use of conventional extracorporeal circulation circuits. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
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Clinical advantages of using mini-bypass systems in terms of Blood Product use, postoperative bleeding and air entrainment: an in vivo clinical perspective
European Journal of Cardio-thoracic Surgery, 2007Co-Authors: Matthias Perthel, Andreas Bendisch, Joachim Laas, L'emir El-ayoubi, Markus GerigkAbstract:Objective: In an effort to minimize the effect of extracorporeal circulation (ECC), mini-bypass is gaining clinical acceptance in routine coronary artery bypass grafting (CABG). These small circuits target combine the clinical advantages of reduced prime, 100% bio-coating and suction Blood separation. We demonstrate that the use of mini-bypass in routine CABG reduces homologous Blood Product use and postoperative bleeding. Our goal was to also demonstrate that these small systems are effective in gaseous microemboli (GME) management as compared to a conventional extracorporeal system. Methods: Prospective, randomized study comparing 30 mini-bypass (Dideco ECC.O™) to 30 conventional systems (n = 30, Dideco 903 Avant™). Study included CABG cases only, independent of preoperative coagulative status; clinic ethical committee approval and informed patient consent was obtained before initiating study. Results: There were no statistical differences in terms of patient demographics. Statistically significant differences were seen in transfusion frequency (27% of the study group vs 43% in the control group, p = 0.05), transfused volume (133.3 ± 244.5 ml vs 325 ± 483.1 ml, p < 0.05), fresh frozen plasma (0 unit vs 3 units, p < 0.001), postoperative bleeding (301.8 ± 531.9 ml vs 785.5 ± 1000.4 ml, p < 0.05) and GME activity post-arterial filter (0.14 μl vs 5.32 μl, p < 0.05). Conclusions: The adoption of mini-bypass significantly potentially reduces hemodilution, donor Blood usage, postoperative bleeding and exposure to GME in routine CABG patients as compared to the use of conventional extracorporeal circulation circuits. © 2007 European Association for Cardio-Thoracic Surgery.
Matthias Perthel - One of the best experts on this subject based on the ideXlab platform.
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clinical advantages of using mini bypass systems in terms of Blood Product use postoperative bleeding and air entrainment an in vivo clinical perspective
European Journal of Cardio-Thoracic Surgery, 2007Co-Authors: Matthias Perthel, Andreas Bendisch, Joachim Laas, Lemir Elayoubi, Markus GerigkAbstract:Objective: In an effort to minimize the effect of extracorporeal circulation (ECC), mini-bypass is gaining clinical acceptance in routine coronary artery bypass grafting (CABG). These small circuits target combine the clinical advantages of reduced prime, 100% bio-coating and suction Blood separation. We demonstrate that the use of mini-bypass in routine CABG reduces homologous Blood Product use and postoperative bleeding. Our goal was to also demonstrate that these small systems are effective in gaseous microemboli (GME) management as compared to a conventional extracorporeal system. Methods: Prospective, randomized study comparing 30 mini-bypass (Dideco ECC.O TM ) to 30 conventional systems (n = 30, Dideco 903 Avant TM ). Study included CABG cases only, independent of preoperative coagulative status; clinic ethical committee approval and informed patient consent was obtained before initiating study. Results: There were no statistical differences in terms of patient demographics. Statistically significant differences were seen in transfusion frequency (27% of the study group vs 43% in the control group, p = 0.05), transfused volume (133.3 244.5 ml vs 325 483.1 ml, p < 0.05), fresh frozen plasma (0 unit vs 3 units, p < 0.001), postoperative bleeding (301.8 531.9 ml vs 785.5 1000.4 ml, p < 0.05) and GME activity post-arterial filter (0.14 ml vs 5.32 ml, p < 0.05). Conclusions: The adoption of mini-bypass significantly potentially reduces hemodilution, donor Blood usage, postoperative bleeding and exposure to GME in routine CABG patients as compared to the use of conventional extracorporeal circulation circuits. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
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Clinical advantages of using mini-bypass systems in terms of Blood Product use, postoperative bleeding and air entrainment: an in vivo clinical perspective
European Journal of Cardio-thoracic Surgery, 2007Co-Authors: Matthias Perthel, Andreas Bendisch, Joachim Laas, L'emir El-ayoubi, Markus GerigkAbstract:Objective: In an effort to minimize the effect of extracorporeal circulation (ECC), mini-bypass is gaining clinical acceptance in routine coronary artery bypass grafting (CABG). These small circuits target combine the clinical advantages of reduced prime, 100% bio-coating and suction Blood separation. We demonstrate that the use of mini-bypass in routine CABG reduces homologous Blood Product use and postoperative bleeding. Our goal was to also demonstrate that these small systems are effective in gaseous microemboli (GME) management as compared to a conventional extracorporeal system. Methods: Prospective, randomized study comparing 30 mini-bypass (Dideco ECC.O™) to 30 conventional systems (n = 30, Dideco 903 Avant™). Study included CABG cases only, independent of preoperative coagulative status; clinic ethical committee approval and informed patient consent was obtained before initiating study. Results: There were no statistical differences in terms of patient demographics. Statistically significant differences were seen in transfusion frequency (27% of the study group vs 43% in the control group, p = 0.05), transfused volume (133.3 ± 244.5 ml vs 325 ± 483.1 ml, p < 0.05), fresh frozen plasma (0 unit vs 3 units, p < 0.001), postoperative bleeding (301.8 ± 531.9 ml vs 785.5 ± 1000.4 ml, p < 0.05) and GME activity post-arterial filter (0.14 μl vs 5.32 μl, p < 0.05). Conclusions: The adoption of mini-bypass significantly potentially reduces hemodilution, donor Blood usage, postoperative bleeding and exposure to GME in routine CABG patients as compared to the use of conventional extracorporeal circulation circuits. © 2007 European Association for Cardio-Thoracic Surgery.
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Reduction in Blood Product usage associated with routine use of mini bypass systems in extracorporeal circulation
Perfusion, 2007Co-Authors: Matthias Perthel, M. Gerick, Andreas Klingbeil, L'emir El-ayoubi, Joachim LaasAbstract:OBJECTIVE: The objective of this study is to investigate the hypothesis that a reduced prime extracorporeal circulation (ECC) system and ensuing reduction in patient hemodilution can affect Blood Product use.\n\nMETHODS: We performed a prospective, randomized study from a group of 60 consecutive coronary artery bypass graft (CABG) patients, comparing Blood Product usage and postoperative bleeding in 30 mini bypass systems (n = 30) to 30 conventional systems (n = 30). The patient demographics in terms of patient weight, height, age, preoperative hemoglobin, preoperative hematocrit, BSA, ejection fraction, and NYHA were not statistically significant.\n\nRESULTS: Blood Product use, including fresh frozen plasma (FFP) and homolgous Blood transfusions was tracked through the operating theater and into the intensive care unit. In the mini bypass group, while no homologous Blood transfusions were given in the OR, 27% of the patients received at least one unit of homologous Blood. In the control group, 43% of the patients received at least one unit of Blood in the OR or in the ICU and there was a stastistically-significant 38% reduction in homologous Blood Product use (p = 0.05). For the patients who received homologous Blood, there was also a significant reduction in transfused volume (0.53 +/- 0.90 units Blood mini bypass vs 1.3 +/- 1.93 units conventional, p < 0.05). In terms of FFP, there was also a stastistically significant difference between the two groups (0 units transfused in mini bypass group vs 3 patients receiving one unit FFP in the control group, p < 0.001). Cumulative postoperative bleeding during the ICU stay was also evaluated, yielding a significant reduction (365 +/- 495 ml mini bypass vs 825 +/- 975 ml conventional, p < 0.05).\n\nCONCLUSION: Mini bypass reduces on-pump hemodilution and, therefore, donor Blood usage in routine CABG patients as compared to conventional ECC circuits and can reduce postoperative bleeding as compared to a traditional system. The mini bypass system is safe in routine clinical use and can manage easily the same number of anastomoses as a traditional system and should be considered a favorable alternative to conventional ECC in all revascularization cases.
Joachim Laas - One of the best experts on this subject based on the ideXlab platform.
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clinical advantages of using mini bypass systems in terms of Blood Product use postoperative bleeding and air entrainment an in vivo clinical perspective
European Journal of Cardio-Thoracic Surgery, 2007Co-Authors: Matthias Perthel, Andreas Bendisch, Joachim Laas, Lemir Elayoubi, Markus GerigkAbstract:Objective: In an effort to minimize the effect of extracorporeal circulation (ECC), mini-bypass is gaining clinical acceptance in routine coronary artery bypass grafting (CABG). These small circuits target combine the clinical advantages of reduced prime, 100% bio-coating and suction Blood separation. We demonstrate that the use of mini-bypass in routine CABG reduces homologous Blood Product use and postoperative bleeding. Our goal was to also demonstrate that these small systems are effective in gaseous microemboli (GME) management as compared to a conventional extracorporeal system. Methods: Prospective, randomized study comparing 30 mini-bypass (Dideco ECC.O TM ) to 30 conventional systems (n = 30, Dideco 903 Avant TM ). Study included CABG cases only, independent of preoperative coagulative status; clinic ethical committee approval and informed patient consent was obtained before initiating study. Results: There were no statistical differences in terms of patient demographics. Statistically significant differences were seen in transfusion frequency (27% of the study group vs 43% in the control group, p = 0.05), transfused volume (133.3 244.5 ml vs 325 483.1 ml, p < 0.05), fresh frozen plasma (0 unit vs 3 units, p < 0.001), postoperative bleeding (301.8 531.9 ml vs 785.5 1000.4 ml, p < 0.05) and GME activity post-arterial filter (0.14 ml vs 5.32 ml, p < 0.05). Conclusions: The adoption of mini-bypass significantly potentially reduces hemodilution, donor Blood usage, postoperative bleeding and exposure to GME in routine CABG patients as compared to the use of conventional extracorporeal circulation circuits. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
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Clinical advantages of using mini-bypass systems in terms of Blood Product use, postoperative bleeding and air entrainment: an in vivo clinical perspective
European Journal of Cardio-thoracic Surgery, 2007Co-Authors: Matthias Perthel, Andreas Bendisch, Joachim Laas, L'emir El-ayoubi, Markus GerigkAbstract:Objective: In an effort to minimize the effect of extracorporeal circulation (ECC), mini-bypass is gaining clinical acceptance in routine coronary artery bypass grafting (CABG). These small circuits target combine the clinical advantages of reduced prime, 100% bio-coating and suction Blood separation. We demonstrate that the use of mini-bypass in routine CABG reduces homologous Blood Product use and postoperative bleeding. Our goal was to also demonstrate that these small systems are effective in gaseous microemboli (GME) management as compared to a conventional extracorporeal system. Methods: Prospective, randomized study comparing 30 mini-bypass (Dideco ECC.O™) to 30 conventional systems (n = 30, Dideco 903 Avant™). Study included CABG cases only, independent of preoperative coagulative status; clinic ethical committee approval and informed patient consent was obtained before initiating study. Results: There were no statistical differences in terms of patient demographics. Statistically significant differences were seen in transfusion frequency (27% of the study group vs 43% in the control group, p = 0.05), transfused volume (133.3 ± 244.5 ml vs 325 ± 483.1 ml, p < 0.05), fresh frozen plasma (0 unit vs 3 units, p < 0.001), postoperative bleeding (301.8 ± 531.9 ml vs 785.5 ± 1000.4 ml, p < 0.05) and GME activity post-arterial filter (0.14 μl vs 5.32 μl, p < 0.05). Conclusions: The adoption of mini-bypass significantly potentially reduces hemodilution, donor Blood usage, postoperative bleeding and exposure to GME in routine CABG patients as compared to the use of conventional extracorporeal circulation circuits. © 2007 European Association for Cardio-Thoracic Surgery.
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Reduction in Blood Product usage associated with routine use of mini bypass systems in extracorporeal circulation
Perfusion, 2007Co-Authors: Matthias Perthel, M. Gerick, Andreas Klingbeil, L'emir El-ayoubi, Joachim LaasAbstract:OBJECTIVE: The objective of this study is to investigate the hypothesis that a reduced prime extracorporeal circulation (ECC) system and ensuing reduction in patient hemodilution can affect Blood Product use.\n\nMETHODS: We performed a prospective, randomized study from a group of 60 consecutive coronary artery bypass graft (CABG) patients, comparing Blood Product usage and postoperative bleeding in 30 mini bypass systems (n = 30) to 30 conventional systems (n = 30). The patient demographics in terms of patient weight, height, age, preoperative hemoglobin, preoperative hematocrit, BSA, ejection fraction, and NYHA were not statistically significant.\n\nRESULTS: Blood Product use, including fresh frozen plasma (FFP) and homolgous Blood transfusions was tracked through the operating theater and into the intensive care unit. In the mini bypass group, while no homologous Blood transfusions were given in the OR, 27% of the patients received at least one unit of homologous Blood. In the control group, 43% of the patients received at least one unit of Blood in the OR or in the ICU and there was a stastistically-significant 38% reduction in homologous Blood Product use (p = 0.05). For the patients who received homologous Blood, there was also a significant reduction in transfused volume (0.53 +/- 0.90 units Blood mini bypass vs 1.3 +/- 1.93 units conventional, p < 0.05). In terms of FFP, there was also a stastistically significant difference between the two groups (0 units transfused in mini bypass group vs 3 patients receiving one unit FFP in the control group, p < 0.001). Cumulative postoperative bleeding during the ICU stay was also evaluated, yielding a significant reduction (365 +/- 495 ml mini bypass vs 825 +/- 975 ml conventional, p < 0.05).\n\nCONCLUSION: Mini bypass reduces on-pump hemodilution and, therefore, donor Blood usage in routine CABG patients as compared to conventional ECC circuits and can reduce postoperative bleeding as compared to a traditional system. The mini bypass system is safe in routine clinical use and can manage easily the same number of anastomoses as a traditional system and should be considered a favorable alternative to conventional ECC in all revascularization cases.
Luc Massicotte - One of the best experts on this subject based on the ideXlab platform.
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aprotinin versus tranexamic acid during liver transplantation impact on Blood Product requirements and survival
Transplantation, 2011Co-Authors: Luc Massicotte, Andre Y Denault, Danielle Beaulieu, Lynda Thibeault, Zoltan HevesiAbstract:Background. Historically, orthotopic liver transplantation (OLT) has been associated with major Blood loss and the need for Blood Product transfusions. Activation of the fibrinolytic system can contribute significantly to bleeding. Prophylactic administration of antifibrinolytic agents was found to reduce Blood loss. Methods. The efficacy of two antifibrinolytic compounds—aprotinin (AP) and tranexamic acid (TA)—was compared in OLT. Four hundred consecutive OLTs were studied: 300 patients received AP and 100 received TA. Multivariate logistic regression analysis was used to identify independent predictors of intraoperative transfusion requirement and 1-year patient mortality. Results. There was no intergroup difference in intraoperative Blood loss (1082± 1056 vs. 1007 ±790 mL), red Blood cell transfusion per patient (0.5 ±1.4 vs. 0.5±1.0), final hemoglobin (Hb) concentration (93 ±20 g/L vs. 95 ±22 g/L), the percentage of OLT cases requiring no Blood Product administration (80% vs. 82%), and 1-year survival (85.1% vs. 87.4%). Serum creatinine concentrations were also the same (116±55 vs. 119±36 μmol/L) 1 year after surgery. Two variables, starting Hb and phlebotomy, correlated with the two primary outcome measures (transfusion and 1-year survival). Conclusions. In our experience, administration of AP was not superior to TA with regards to Blood loss and Blood Product transfusion requirement during OLT. In addition, we found no difference between the groups in the 1-year survival rate and renal function. Furthermore, we suggest that starting Hb concentration should be considered when prioritizing patients on the waiting list and planning perioperative care for OLT recipients.
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meld score and Blood Product requirements during liver transplantation no link
Transplantation, 2009Co-Authors: Luc Massicotte, Danielle Beaulieu, Denis Marleau, Frank Vandenbroucke, Michel Dagenais, Real LapointeAbstract:Background. Orthotopic liver transplantation has been traditionally associated with major Blood loss and the need for allogenic Blood Product transfusions. In recent years, improvements in surgical and anesthetic techniques have greatly decreased the amount of Blood Products transfused. We have published a median of 0 for all intraoperative Blood Products transfused. Some authors argue that these results could be possible merely because of the relatively healthy cohort in terms of model of end-stage liver disease (MELD) score. The MELD score could be adjusted by some conditions (hepatocellular carcinoma, hemodialysis, hepatopulmonary syndrome, and amyloidosis) and was not adjusted in these series. The goal of this work was to verify the MELD score according to US standards and to find any link between the MELD score and the transfusion rate. Method. Three hundred fifty consecutive liver transplantations were studied. The MELD score was adjusted according to US standards. Patients were divided into two groups according to the median of the MELD score. Blood loss and transfusion rate were determined for these two groups. Logistic regression models were used to find any link with transfusion of red Blood cell (RBC) units. Result. The MELD score before adjusting was 19±9 9 and 22± 10 after. A mean of 0.5±1.3 RBC units/patient intraoperative were transfused with 80.6% of cases without any Blood Products. There was no difference for the Blood loss (999±670 mL vs. 1017±885 mL) or the transfusion rate (0.4±1.2 vs. 0.5±1.4 RBC/patient) between two groups of MELD (<21 or ≥21) or any of its component (creatinine, bilirubin, and international normalized ratio). The logistic regression analysis found that only two variables were linked to RBC transfusion; starting hemoglobin value and phlebotomy. Conclusion. In this series, the MELD score was as high as US series and did not predict Blood losses and Blood Product requirement during liver transplantation. If the MELD system has to be implemented to prioritize orthotopic liver transplantation, it should be revisited, and the starting hemoglobin value should be added to the equation.
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coagulation defects do not predict Blood Product requirements during liver transplantation
Transplantation, 2008Co-Authors: Luc Massicotte, Danielle Beaulieu, Lynda Thibeault, Denis Marleau, Real LapointeAbstract:Background. In our experience, correction of coagulation defects with plasma transfusion does not decrease the need for intraoperative red Blood cell (RBC) transfusions during liver transplantation. On the contrary, it leads to a hypervolemic state that result in increased Blood loss. A previous study has shown that plasma transfusion has been associated with a decreased 1-year survival rate. The aim of this prospective study was to evaluate whether anesthesiologists could reduce RBC transfusion requirements during liver transplantation by eliminating plasma transfusion. Methods. Two hundred consecutive liver transplantations were prospectively studied over a 3-year period. Patients were divided into two groups: low starting international normalized ratio (INR) value <1.5 and high INR≥1.5. Low central venous pressure was maintained in all patients before the anhepatic phase. Coagulation parameters were not corrected preoperatively or intraoperatively in the absence of uncontrollable bleeding. Phlebotomy and auto transfusion of Blood salvaged were used following our protocol. Independent variables were analyzed in both univariate and multivariate fashion to find a link with RBC transfusions or decreased survival rate. Results. The mean number of intraoperative RBC units transfused was 0.3±0.8. Plasma, platelet, albumin, and cryoprecipitate were not transfused. In 81.5% of the patients, no Blood Product was used during their transplantation. The average final hemoglobin (Hb) value was 91.2± 15.0 g/L. There were no differences in transfusional rate, final Hb, or bleeding between two groups (low or high INR values). The overall 1-year survival rate was 85.6%. Logistic regression showed that avoidance of plasma transfusion, phlebotomy, and starting Hb value were significantly linked to liver transplantation without RBC transfusion. The need for intraoperative RBC transfusion and Pugh's score were linked to the decreased 1-year survival rate. Conclusion. The avoidance of plasma transfusion was associated with a decrease in RBC transfusions during liver transplantation. There was no link between coagulation defects and bleeding or RBC or plasma transfusions. Previous reports indicating that it is neither useful nor necessary to correct coagulation defects with plasma transfusion before liver transplantation seem further corroborated by this study. We believe that this work also supports the practice of lowering central venous pressure with phlebotomy to reduce Blood loss, during liver dissection, without any deleterious effect.
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effect of low central venous pressure and phlebotomy on Blood Product transfusion requirements during liver transplantations
Liver Transplantation, 2006Co-Authors: Luc Massicotte, Lynda Thibeault, Serge Lenis, Mariepascale Sassine, Robert F SealAbstract:Correction of coagulation defects with plasma transfusion did not decrease the need for intraoperative red Blood cells (RBC) transfusions during liver transplantations. On the contrary, it led to a hypervolemic state that resulted in an increase of shed Blood. As well, plasma transfusion has been associated with a decreased one-year survival rate. The aim of the present prospective survey was to evaluate whether anesthesiologists could reduce intraoperative RBC transfusions during liver transplantations by changing their anesthesia practice, more specifically by maintaining a low central venous pressure (CVP), through restriction of volume replacement, elimination of all plasma transfusion and by using intraoperative phlebotomy during the transplantation. One hundred consecutive liver transplantations were prospectively studied during a two-year period and were compared to a retrospective series (1998-2002). A low CVP was maintained in all patients prior the anhepatic phase. Coagulation disorders were not corrected preoperatively, intraoperatively, or post-operatively unless uncontrollable bleeding. Phlebotomy and Cell Saver (CS) were used following pre-established criteria. Independent variables were analyzed in a univariate and multivariate fashion. The mean number of intraoperative RBC units transfused was 0.4 ± 0.8. No plasma, platelets, albumin, or cryoprecipitate were transfused. Seventy-nine percent of the patients received no Blood Products during their liver transplantation. The average final hemoglobin value was 85.9 ± 17.8 g/L. In 57 patients (58.2%), intraoperative phlebotomy and CS were used either together or separately. The one-year year survival rate was 89.1%. Logistic regression showed that avoidance of plasma transfusion, starting hemoglobin value and phlebotomy were significantly linked to liver transplantation without RBC transfusion. In conclusion, the avoidance of plasma transfusion and maintenance of a low CVP prior to the anhepatic phase were associated with a decrease in RBC transfusions during liver transplantations. Previous reports indicating that it is neither useful nor necessary to correct coagulation defects with plasma transfusion prior to liver transplantation are further corroborated by this prospective survey. We believe that this work also supports the practice of lowering CVP with phlebotomy in order to reduce Blood loss, during liver dissection, without any deleterious effect. Liver Transpl 12:117–123, 2006. © 2005 AASLD.
Andreas Bendisch - One of the best experts on this subject based on the ideXlab platform.
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clinical advantages of using mini bypass systems in terms of Blood Product use postoperative bleeding and air entrainment an in vivo clinical perspective
European Journal of Cardio-Thoracic Surgery, 2007Co-Authors: Matthias Perthel, Andreas Bendisch, Joachim Laas, Lemir Elayoubi, Markus GerigkAbstract:Objective: In an effort to minimize the effect of extracorporeal circulation (ECC), mini-bypass is gaining clinical acceptance in routine coronary artery bypass grafting (CABG). These small circuits target combine the clinical advantages of reduced prime, 100% bio-coating and suction Blood separation. We demonstrate that the use of mini-bypass in routine CABG reduces homologous Blood Product use and postoperative bleeding. Our goal was to also demonstrate that these small systems are effective in gaseous microemboli (GME) management as compared to a conventional extracorporeal system. Methods: Prospective, randomized study comparing 30 mini-bypass (Dideco ECC.O TM ) to 30 conventional systems (n = 30, Dideco 903 Avant TM ). Study included CABG cases only, independent of preoperative coagulative status; clinic ethical committee approval and informed patient consent was obtained before initiating study. Results: There were no statistical differences in terms of patient demographics. Statistically significant differences were seen in transfusion frequency (27% of the study group vs 43% in the control group, p = 0.05), transfused volume (133.3 244.5 ml vs 325 483.1 ml, p < 0.05), fresh frozen plasma (0 unit vs 3 units, p < 0.001), postoperative bleeding (301.8 531.9 ml vs 785.5 1000.4 ml, p < 0.05) and GME activity post-arterial filter (0.14 ml vs 5.32 ml, p < 0.05). Conclusions: The adoption of mini-bypass significantly potentially reduces hemodilution, donor Blood usage, postoperative bleeding and exposure to GME in routine CABG patients as compared to the use of conventional extracorporeal circulation circuits. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
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Clinical advantages of using mini-bypass systems in terms of Blood Product use, postoperative bleeding and air entrainment: an in vivo clinical perspective
European Journal of Cardio-thoracic Surgery, 2007Co-Authors: Matthias Perthel, Andreas Bendisch, Joachim Laas, L'emir El-ayoubi, Markus GerigkAbstract:Objective: In an effort to minimize the effect of extracorporeal circulation (ECC), mini-bypass is gaining clinical acceptance in routine coronary artery bypass grafting (CABG). These small circuits target combine the clinical advantages of reduced prime, 100% bio-coating and suction Blood separation. We demonstrate that the use of mini-bypass in routine CABG reduces homologous Blood Product use and postoperative bleeding. Our goal was to also demonstrate that these small systems are effective in gaseous microemboli (GME) management as compared to a conventional extracorporeal system. Methods: Prospective, randomized study comparing 30 mini-bypass (Dideco ECC.O™) to 30 conventional systems (n = 30, Dideco 903 Avant™). Study included CABG cases only, independent of preoperative coagulative status; clinic ethical committee approval and informed patient consent was obtained before initiating study. Results: There were no statistical differences in terms of patient demographics. Statistically significant differences were seen in transfusion frequency (27% of the study group vs 43% in the control group, p = 0.05), transfused volume (133.3 ± 244.5 ml vs 325 ± 483.1 ml, p < 0.05), fresh frozen plasma (0 unit vs 3 units, p < 0.001), postoperative bleeding (301.8 ± 531.9 ml vs 785.5 ± 1000.4 ml, p < 0.05) and GME activity post-arterial filter (0.14 μl vs 5.32 μl, p < 0.05). Conclusions: The adoption of mini-bypass significantly potentially reduces hemodilution, donor Blood usage, postoperative bleeding and exposure to GME in routine CABG patients as compared to the use of conventional extracorporeal circulation circuits. © 2007 European Association for Cardio-Thoracic Surgery.
