Thromboelastography after Cardiopulmonary Bypass: Does it Save Blood Products? TEG after Cardiopulmonary Bypass

Introduction.  This study aimed to determine if thromboelastography (TEG) is associated with reduced blood product use and surgical re-intervention following cardiopulmonary bypass (CPB) compared to traditional coagulation tests. Methods.  A retrospective review was conducted of 698 patients who underwent CPB  at a tertiary-care, community-based, university-affiliated hospital from February 16, 2014 – February 16, 2015 (Period I) and May 16, 2015 - May 16, 2016 (Period II).  Traditional coagulation tests guided transfusion during Period I and TEG guided transfusion during Period II.  Intraoperative and postoperative administration blood products (red blood cells, fresh frozen plasma, platelets, and cryoprecipitate), reoperation for hemorrhage or graft occlusion, duration of mechanical ventilation, hospital length of stay and mortality were recorded.  Results.  Use of a TEG-directed algorithm was associated with a 13.5% absolute reduction in percentage of patients requiring blood products intraoperatively (48.2% vs. 34.7%, p <0.001).  TEG resulted in a 64.3% and 43.1% reduction in proportion of patients receiving FFP and platelets, respectively, with a 50% reduction in volume of FFP administered (0.3 vs. 0.6 units, p < 0.001).  Use of TEG was not observed to significantly decrease postoperative blood product usage or mortality.  The median length of hospital stay was reduced by 1 day after TEG guided transfusion was implemented (nine days vs. eight days, p = 0.01). Conclusions.  Use of TEG-directed transfusion of blood products following CPB appears to decrease the need for intraoperative transfusions, but the effect on clinical outcomes has yet to be clearly determined

Transfemoral Transcatheter Mitral Valve Implantation With a Dedicated Device in a Rheumatic Mitral Stenosis Patient

A 65-year-old obese woman with rheumatic heart disease and restrictive lung disease presented with decompensated heart failure. Evaluation demonstrated severely thickened mitral valve leaflets, severe mitral stenosis, and moderate mitral regurgitation. She underwent successful transfemoral transseptal transcatheter mitral valve replacement with a dedicated valve resulting in improved functional status. (Level of Difficulty: Advanced.