Evaluation of hypercoagulability status after off-pump coronary artery bypass grafting using rotation thromboelastometry

Background: Recently, off-pump coronary artery bypass (OPCAB) surgery, which dose not require cardiopulmonary bypass (CPB), has been commonly performed. It has been revealed that OPCAB decreases the incidence of perioperative infarctions triggered by thrombolism from aorta. However, OPCAB has also been associated with postoperative stroke. Thromboelastography (TEG) is a bedside blood test that can be used to defi ne the viscoelastic properties of blood. ROTEM® analyzer (Pentapharm GmbH, Munich,Germany) is a modifi ed form of TEG. The aim of this study is to evaluate the hypercoagulability status of the blood after OPCA Bsurgery by using ROTEM®.Methods: This is a prospective study of 10 OPCAB patients each who underwent OPCAB, on-pump surgery, AAA repair, and VATS for a period of 7 days with ROTEM® assays. From ROTEM data, Coagulation Index (CI) was calculated for each patient.Results: The CI values of OPCAB patients from the extrinsic assay during the perioperative period were consistent with hypercoagulability. In comparison between the OPCAB and CPB patients from the extrinsic assay, a signifi cant difference was observed during the postoperative state. Comparison between the OPCAB and AAA patients revealed significantly higher CI values in the OPCAB patients immediately after surgery. Similarly, comparison between the OPCAB and VATS patients revealed significantly higher CI values in the OPCAB patients through the entire course of measurements.Conclusions: A state of hypercoagulability of the blood, as measured by ROTEM, existed in the OPCAB patients beyond acute postoperative stage. The extrinsic coagulation, in particular, was hypercoagulable in the OPCAB patients.departmental bulletin pape

Novel measurement method for mitral valve anterior leafl et free margin length using 3DTEE

Background: The aim of our study is to establish an accurate measurement method for anterior mitral leafl et (AML) free margin length, which is a key aspect for prediction of the extent of resection in anterior mitral valve (MV) leafl et repair.Method: Among the patients who underwent anterior MV leafl et repair between July 2010 and August 2012, we studied 17 patients with data on 3D echocardiography obtained pre- and intra-operatively and intraoperative direct measurements of AML free margin.The AML free margin lengths measured at different frames (early-opening frame of MV and end-opening frame of MV) by using realtime 3D transesophageal echocardiography (RT-3DTEE) were compared with the values directly measured during mitral valvuloplasty (MVP). For acquisition of 3D data during surgery, RT-3DTEE images of MV were obtained by using the Philips iE33 echocardiography system with X7-2 probe before MVP.Result: The free margin length values measured with Q-LAB MVQ. Regarding the correlation between the measured values with the RT-3DTEE and values directly measured intraoperatively, the measured values at the early-opening frame of MV had no correlation between the actual measured values and r-value = 0.338 (P=0.184). Conversely, the measured values at the end-opening frame of MV had an extremely high signifi cant correlation between the measured values and r-value = 0.980 (P<0.0001).Conclusion: In conclusion, the novel measurement method enables measurement of anterior mitral leafl et free margin length by using RT-3DTEE. At the end-opening frame of MV, the novel measurement method that refl ects more accurate actual measured value was established.departmental bulletin pape