Impact of inferior vena cava obstruction during orthotopic liver transplantation without venovenous bypass grafting on early postoperative renal function (pilot analysis)

Ligation of the inferior vena cava (IVC) during classical orthotopic liver transplantation (OLT) may be followed by pronounced hemodynamic changes and may provoke renal dysfunction. The authors have examined the impact of IVC ligation during OLT without venovenous bypass grafting on early postoperative renal function in 6 patients. The Cockcroft-Gault formula was used to evaluate renal function from the creatinine clearance on postoperative days 1, 3, 7, and 10. The endogenous creatinine clearance was diminished within the first 24 hours after surgery; this was 68.2±18.1 (24.3—146) ml/min and significantly correlated with that before OLT, with the mean blood pressure (BPmean) in the icteric period, and with age. At the same time, icteric BPmean was in the normal range — 77.2±1.59 (71.6—81.6) mm Hg and clinical renal failure developed in a female patient with significant preoperative renal dysfunction. Thus, IVC ligation at OLT with IVC interposition in the study contributed to a lower endogenous creatinine clearance within the first 24 postoperative hours, but results in no clinical renal function aggravation

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

AIMS: Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS: A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS: The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks