Andreas Koster

..This requires monitoring of the ecarin clotting time. No commercial ecarin clotting time assay is available for clinical use. We adapted the ecarin clotting time to the easy-to-handle ACT II device...

..These results suggest that bivalirudin, given according to the current protocol, provides reliable and effective anticoagulation during off-pump coronary artery bypass graft surgery...

....

..However, this poses a problem in patients insensitive to heparin. The present investigation was performed to assess different strategies of managing patients with heparin resistance during CPB...

..Our data show that bivalirudin can be effectively eliminated via hemofiltration and plasmapheresis, although there were significant differences in the elimination rates among the filter systems investigated...

..However, further attenuation of hemostatic activation can be achieved by further closing the system and minimizing the blood/air interface by passive venting of the heart...

..This effect can most likely be attributed to the antifibrinolytic effects of aprotinin, as we did not observe effects on other variables of activation of the hemostatic/inflammatory system...

..Our data provide the first evidence of clinical feasibility of anticoagulation with bivalirudin during cardiopulmonary bypass...

..55 kg Jehovah's Witness neonate boy...

..This study was conducted to assess the effects of the currently suggested protocol for bivalirudin on hemostatic activation during cardiopulmonary bypass with and without cardiotomy suction...

..IMPLICATIONS: During cardiopulmonary bypass, the plasma modified kaolin activated clotting time (ACT) provides a better correlation with heparin levels than the standard kaolin ACT...

..We assessed the occurrence of this disease and its influence on clinical outcome in patients after implantation of a ventricular assist device (VAD)...

....

..To assess the cross-reactivity of danaparoid sodium in patients undergoing cardiovascular surgery...

....

..We analyzed the occurrence of HPF4/A and thromboembolism in patients with heparin-coated and noncoated VADs...

..The authors investigated a new concept using unfractionated heparins after platelet inhibition with the short-acting platelet glycoprotein IIb-IIIa antagonist tirofiban...

..We assessed the effect of four different strategies of modified ultrafiltration after cardiopulmonary bypass on the bivalirudin elimination and postoperative blood loss...

..The subsidence coefficient b revealed no significant differences in elimination between the filter systems. These data suggest that ultrafiltration is an effective means for extracorporeal elimination of therapeutic levels of tirofiban...

..However, elaboration is desirable, and larger clinical trials are necessary for a final evaluation of the protocol...

..Surgery was successfully performed with moderate intraoperative and postoperative blood loss and transfusion requirements...

..Otherwise, the combination of UFH with a potent antiplatelet agent, especially with short-acting GP IIb/IIIa antagonists, is an attractive alternative...

..Further improvement may be achieved using a modified RTG by adding plasma coagulation factors in one channel for an improved evaluation of platelet function, even under the condition of a loss of procoagulants...

..Moreover, we evaluated potential benefits of near-infrared spectroscopic monitoring of regional tissue oxygenation...

..The postoperative course was uneventful and the patient was discharged from hospital after 5 days. CONCLUSION: Bivalirudin can be safely used for anticoagulation during CPB even in complex cardiac surgery...

..The present case demonstrates successful weaning and complete removal of an apical venting pulsatile LVAD in a 4-kg infant without the employment of CPB...

..5 g/dL. The hemoglobin concentrations measured during CPB ranged from 5.9 to 6.5 g/dL, 6.4 to 6.8 g/dL, and 5.5 to 5.9 g/dL, respectively. The patients did not receive any blood or blood products during their entire hospital stay...

..The goal of safe, transfusion-free surgery was achieved chiefly by minimizing the priming volume of the cardiopulmonary bypass circuit to 200 mL while providing adequate flow and standard safety features...

..We compared the coagulation disorders and the need for blood products in children treated either with extracorporeal membrane oxygenation (ECMO) or with the Berlin Heart pulsatile pneumatic ventricular assist device...

..Nevertheless, indications for and timing of the implantation of a VAD in patients who have received an intra-aortic balloon pump (IABP) remain unclear...

..The use of ventricular assist devices (VADs) in patients with chronic end-stage or acute heart failure has led to improved survival. We present our experience since 1987...

....

..Stringent improvement of these strategies, particularly the downsizing of the cardiopulmonary bypass system, have now enabled a transfusion-free arterial switch operation in a 1700-gram prematurely born neonate...

....

....

..This shows that parallel near-infrared spectroscopy of the brain and the lower extremities may represent a novel non-invasive monitoring technique to ensure adequate cerebral and extracerebral perfusion during cardiopulmonary bypass...

..The degree of haemodilution and, thus, the requirements for blood transfusion may be reduced when the CPB circuit is miniaturized without compromising patient safety...

..We report on our efforts to minimize the CPB system and adjust the perfusion strategy to the goal of transfusion-free CPB in a 3.7 kg neonate scheduled for repair of transposition of the great arteries...

..We combined the normothermic cross-clamping technique with a blood conservation strategy...

..Instead, complete coronary artery revascularization was successfully performed off-pump using bivalirudin as the anticoagulant...

..This effect may contribute to the benefits of direct thrombin inhibitors seen in clinical studies after treatment for acute coronary syndromes...

..To test whether inhalation of the phosphodiesterase 3 inhibitor milrinone may attenuate experimental acute lung injury (ALI)...

..5 microm and 3 microm may be explained by a possible filtering capacity of membrane oxygenators. The 0.2 microm PBF is an effective tool to reduce the particle load in the CPB priming fluid...

..Because this operation is associated with significant morbidity and mortality, it is important to select patients for TMR who are likely to benefit from the procedure...

....

..Recent problems associated with the production of heparin have emphasized the urgent need for an alternative for use beyond the limited indication of heparin-induced thrombocytopenia...

..In patients with low-output syndrome despite IABP support, implantation of a ventricular assist system should be considered...

..To detect the flow in peripheral vessels, we measured transcranial Doppler signals in patients after implantation...

....

..6) and at discharge it was 7.1 - 14.5 g/dl (mean 15.5). No blood or blood products were used in any patient. CONCLUSION: Bloodless cardiac surgery with and without CPB can be safely performed in Jehovah's Witness infants and children...

..In our study we investigated, how preoperative ventricular dysfunction influences long term survival after coronary bypass surgery...

..In our judgment, a floating mass in the ascending aorta represents an emergency and should be removed before major thromboembolic complications occur...

..In one patient with preoperatively noted MES the prevalence of MES postoperatively was 50%. The high speed rotating impeller of the DeBakey VAD did not produce any detectable microthrombi or bubbles from cavitation effects...

..The data presented provide evidence that autologous plasma and platelet sequestration during CPB initiation is effective. The harvested material reveals a high platelet count and fibrinogen level and preserves functional integrity...

..Further investigations are necessary for evaluation of the pathophysiologic mechanism and clinical implications of these findings...

..Additionally, data from clinical trials with argatroban use outside HIT, in more special indications such as in percutaneous coronary intervention, stroke, renal replacement therapy, and intensive care medicine, are reviewed...

..Therefore inhibition of p38 or components of the p38 pathway could be a promising and selective antiinflammatory therapeutic target after hypothermic CPB...

..Anecdotal 'off-label' experience for the treatment of heparin-induced thrombocytopenia shows promise...

....

..The novel short-acting, direct-thrombin inhibitor bivalirudin is the only alternative to heparin/protamine being used in elective non-HIT patients during CPB...

..For patients receiving VKAs at the time of diagnosis of HIT, we recommend use of vitamin K (10 mg po or 5 to 10 mg IV) [Grade 1C]...

..This trial was performed to evaluate the safety and efficacy of bivalirudin as an alternative to heparin with protamine reversal in on-pump cardiac surgery...

..This trial was performed to evaluate the safety and efficacy of bivalirudin in off-pump coronary artery bypass grafting...

..This is evidenced by low hospital mortality and morbidity rates. Further follow-up is warranted to discern the influence of bivalirudin on long-term clinical outcomes...

..The ACTT assay is sensitive to levels of bivalirudin and may offer a simple method for monitoring bivalirudin during cardiac surgery...

....

..This variability is attributable to multiple factors, including lack of correction for deoxygenated hemoglobin (Haldane effect)...