- Email: [email protected]
190Factor VIII inhibitor bypassing activity (FEIBA) as an adjunct in post-cardiotomy bleeding
S129
Abstracts
pendent effect of weekend discharge on overall rates of 30-day adverse events was determined using multivariable regression modeling. A total of 2747 patients were considered (weekday: n ⫽ 1884; weekend: n ⫽ 863). Patients discharged home on weekends were less likely to have been ⬎ 70yrs (29.3% vs. 33.2%, P ⫽ 0.04) and to have had pre-operative atrial fibrillation (4.0% vs. 6.4%, P ⫽ 0.01). Post-operatively, they were less likely to have had atrial fibrillation (23.3% vs. 35.2%, P ⬍ 0.0001) and renal failure (4.2% vs. 7.0%, P ⫽ 0.005) and to have been discharged home on the provincial homecare program (7.9% vs. 11.7%, P ⫽ 0.003). They also experienced a shorter post-operative length of stay (4.9 days vs. 5.4 days, P ⬍ 0.0001). Overall rates of 30-day adverse events did not differ between the two groups (28.2% vs. 31.1%, P ⫽ 0.12). Following adjustment for differences between the two groups, weekend discharge did not emerge as a significant predictor of worse short-term outcomes following cardiac surgery (OR 0.94, 95% CI 0.78-1.13). CONCLUSION: Weekend discharge following cardiac surgery is safe. However, patients with post-operative atrial fibrillation, renal failure and need for homecare were less likely to be discharged home on weekends. This may highlight the reduced availability of resources on weekends which, in turn, may have prolonged hospital length of stay in these patients and, ultimately, increased cost to the health care system.
190 FACTOR VIII INHIBITOR BYPASSING ACTIVITY (FEIBA) AS AN ADJUNCT IN POST-CARDIOTOMY BLEEDING MP Pelletier, M Rioux, A Hassan, R Forgie, C Brown Saint John, New Brunswick
Refractory bleeding after cardiac surgery continues to be a significant challenge. Post-bypass coagulopathy requiring multiple transfusions is associated with higher levels of morbidity and mortality. This problem has been exacerbated in recent years by the increased use of antiplatelet agents and the loss of aprotinin. Factor eight inhibitor bypassing activity (FEIBA) is a coagulation factor concentrate commonly used in haemophelia, but it has also shown some promise in postoperative hemostasis. We report on the largest known series of its use in post-cardiotomy coagulopathy. METHODS: A retrospective review of 81 consecutive cases involving the use of FEIBA at a provincial cardiac surgical program was performed. RESULTS: From Jan 1, 2008 to Sep 30, 2010, a total of 81 patients received FEIBA for bleeding refractory to routine adjunct therapy such as platelets, fresh frozen plasma (FFP) and cryoprecipitate administration. 28 patients received intra-operative doses only, 44 received postoperative doses only, and 9 received both intra- and post-operative doses. Average age was 66.5 years, with 50 males and 31 females. 18 cases were isolated CABG with all other cases being concomitant procedures or INTRODUCTION:
complex urgent cases. For the 37 patients who received intraoperative FEIBA, average CPB time was 237 minutes (S.D. ⫾ 82) and all patients were still bleeding after receiving standard coagulation factors. The average FEIBA dose was 939 Units (S.D. ⫾ 203) and adequate hemostasis allowed for sternal closure in all patients. 28 patients did not receive additional FEIBA, average blood loss over first 12 hours was 677 mls (S.D. ⫾ 314), and only 1 patient required re-exploration. 9 patients were given a second dose postoperatively and 4 patients required re-exploration (4/37, 10.8%). For patients receiving post-operative FEIBA only, average CPB time was 139 minutes (S.D. ⫾ 57), average blood loss was 1271 mls ( ⫾ 455) before FEIBA and 121 mls in the first hour after FEIBA. 9 of those patients required re-exploration. In all 81 patients, there were no strokes or perioperative myocardial infarctions, and 1 mortality (1.2%). Renal insufficiency developed in 12 patients (14.8%). CONCLUSIONS: Intra- or post-operative use of FEIBA appears to be effective in controlling refractory bleeding post-cardiotomy, with acceptable rates of complications in a high risk surgical cohort. A prospective randomized trial to further determine this drug’s efficacy may be warranted.
Canadian Cardiovascular Society (CCS) CCS160 Poster EXPERIMENTAL CARDIAC REGENERATION AND CLINICAL PCI ISSUES Monday, October 24, 2011
193 EVALUATION OF THE MEDTRONIC RESTING-HEART-SYSTEM™ (RHS) WITH RESPECT TO MICROBUBBLE ACTIVITY (MBBA) IN THE TUBINGS OF THE CIRCUIT M Perthel, E Kraatz Bad Segeberg, Germany
Complete revascularization with Extracorporeal Circulation (ECC) and cardioplegic arrest is still the most common surgical treatment of coronary artery disease. MBBa is often detected at some level in the circuit of ECC and is a risk factor for postoperative morbidity. Mini-bypass systems such as the RHS could reduce circulating microair. METHODS: In 20 consecutive patients coronary artery bypass grafting (CABG) was performed with RHS. The volume of MBBa was calculated with a special developed device (GAMPT-System™) in the venous line (before reservoir) and the arterial line (after the filter). Filter was the same model in both systems. Data were compared to 20 consecutive patients who were operated using a conventional setup previously. RESULTS: There was no mortality or conversion of RHS to conventional system. Groups matched with respect to patients characteristics (age, gender) and operation times.
Abstracts
pendent effect of weekend discharge on overall rates of 30-day adverse events was determined using multivariable regression modeling. A total of 2747 patients were considered (weekday: n ⫽ 1884; weekend: n ⫽ 863). Patients discharged home on weekends were less likely to have been ⬎ 70yrs (29.3% vs. 33.2%, P ⫽ 0.04) and to have had pre-operative atrial fibrillation (4.0% vs. 6.4%, P ⫽ 0.01). Post-operatively, they were less likely to have had atrial fibrillation (23.3% vs. 35.2%, P ⬍ 0.0001) and renal failure (4.2% vs. 7.0%, P ⫽ 0.005) and to have been discharged home on the provincial homecare program (7.9% vs. 11.7%, P ⫽ 0.003). They also experienced a shorter post-operative length of stay (4.9 days vs. 5.4 days, P ⬍ 0.0001). Overall rates of 30-day adverse events did not differ between the two groups (28.2% vs. 31.1%, P ⫽ 0.12). Following adjustment for differences between the two groups, weekend discharge did not emerge as a significant predictor of worse short-term outcomes following cardiac surgery (OR 0.94, 95% CI 0.78-1.13). CONCLUSION: Weekend discharge following cardiac surgery is safe. However, patients with post-operative atrial fibrillation, renal failure and need for homecare were less likely to be discharged home on weekends. This may highlight the reduced availability of resources on weekends which, in turn, may have prolonged hospital length of stay in these patients and, ultimately, increased cost to the health care system.
190 FACTOR VIII INHIBITOR BYPASSING ACTIVITY (FEIBA) AS AN ADJUNCT IN POST-CARDIOTOMY BLEEDING MP Pelletier, M Rioux, A Hassan, R Forgie, C Brown Saint John, New Brunswick
Refractory bleeding after cardiac surgery continues to be a significant challenge. Post-bypass coagulopathy requiring multiple transfusions is associated with higher levels of morbidity and mortality. This problem has been exacerbated in recent years by the increased use of antiplatelet agents and the loss of aprotinin. Factor eight inhibitor bypassing activity (FEIBA) is a coagulation factor concentrate commonly used in haemophelia, but it has also shown some promise in postoperative hemostasis. We report on the largest known series of its use in post-cardiotomy coagulopathy. METHODS: A retrospective review of 81 consecutive cases involving the use of FEIBA at a provincial cardiac surgical program was performed. RESULTS: From Jan 1, 2008 to Sep 30, 2010, a total of 81 patients received FEIBA for bleeding refractory to routine adjunct therapy such as platelets, fresh frozen plasma (FFP) and cryoprecipitate administration. 28 patients received intra-operative doses only, 44 received postoperative doses only, and 9 received both intra- and post-operative doses. Average age was 66.5 years, with 50 males and 31 females. 18 cases were isolated CABG with all other cases being concomitant procedures or INTRODUCTION:
complex urgent cases. For the 37 patients who received intraoperative FEIBA, average CPB time was 237 minutes (S.D. ⫾ 82) and all patients were still bleeding after receiving standard coagulation factors. The average FEIBA dose was 939 Units (S.D. ⫾ 203) and adequate hemostasis allowed for sternal closure in all patients. 28 patients did not receive additional FEIBA, average blood loss over first 12 hours was 677 mls (S.D. ⫾ 314), and only 1 patient required re-exploration. 9 patients were given a second dose postoperatively and 4 patients required re-exploration (4/37, 10.8%). For patients receiving post-operative FEIBA only, average CPB time was 139 minutes (S.D. ⫾ 57), average blood loss was 1271 mls ( ⫾ 455) before FEIBA and 121 mls in the first hour after FEIBA. 9 of those patients required re-exploration. In all 81 patients, there were no strokes or perioperative myocardial infarctions, and 1 mortality (1.2%). Renal insufficiency developed in 12 patients (14.8%). CONCLUSIONS: Intra- or post-operative use of FEIBA appears to be effective in controlling refractory bleeding post-cardiotomy, with acceptable rates of complications in a high risk surgical cohort. A prospective randomized trial to further determine this drug’s efficacy may be warranted.
Canadian Cardiovascular Society (CCS) CCS160 Poster EXPERIMENTAL CARDIAC REGENERATION AND CLINICAL PCI ISSUES Monday, October 24, 2011
193 EVALUATION OF THE MEDTRONIC RESTING-HEART-SYSTEM™ (RHS) WITH RESPECT TO MICROBUBBLE ACTIVITY (MBBA) IN THE TUBINGS OF THE CIRCUIT M Perthel, E Kraatz Bad Segeberg, Germany
Complete revascularization with Extracorporeal Circulation (ECC) and cardioplegic arrest is still the most common surgical treatment of coronary artery disease. MBBa is often detected at some level in the circuit of ECC and is a risk factor for postoperative morbidity. Mini-bypass systems such as the RHS could reduce circulating microair. METHODS: In 20 consecutive patients coronary artery bypass grafting (CABG) was performed with RHS. The volume of MBBa was calculated with a special developed device (GAMPT-System™) in the venous line (before reservoir) and the arterial line (after the filter). Filter was the same model in both systems. Data were compared to 20 consecutive patients who were operated using a conventional setup previously. RESULTS: There was no mortality or conversion of RHS to conventional system. Groups matched with respect to patients characteristics (age, gender) and operation times.