| Fibrinogen Level and Its Influence
on Cardiopulmonary Bypass in Surgery for Aortic Dissection |
(Department of Cardiovascular Surgery, National
Hospital Tokyo Disaster Medical Center, Tokyo, Japan and The Second
Department of Surgery, Nihon University School of Medicine*, Tokyo,
Japan)
| Saeki Tsukamoto |
Shoji Shindo |
Masahiro Obana |
| Kenji Akiyama* |
Motomi Shiono* |
Nanao Negishi* |
|
For the purpose of reducing blood
loss and blood transfusion, 100 cases of acute aortic dissection
treated at this department were studied, focusing on surgery
for aortic dissection and coagulation factors, fibrinogen in
particular. In cases of aortic dissection, fibrinogen decreased
at the acute stage, and showed concentrations significantly lower
in Stanford Type A than in Stanford Type B, in extensive dissection
(DeBakey Type I or Type III retrograde dissection) than in limited
dissection (DeBakey Type II), and in open false lumen type than
in closed false lumen type. In the assessment of 34 cases of
acute Stanford Type A aortic dissection operated on within 24h
of onset, it was found that a marked prolongation of activated
clotting time (ACTł1,000s) during cardiopulmonary bypass causes
an increase in blood transfusion. When ACT was maintained for
400s or longer, to inhibit the marked prolongation of ACT, by
changing at any time the dose of heparin during cardiopulmonary
bypass by 50 -250units/kg on the basis of the preoperative fibrinogen
level, instead of fixing it at 300units/kg, ACT decreased significantly,
and was controlled at appropriate levels despite the low concentration
of fibrinogen. As fibrinogen can be measured in the hospital,
and the result obtained in a short time, it is considered to
play an important role in controlling ACT to determine the dose
of heparin based on its concentration.
@Jpn. J. Cardiovasc. Surg. 32F121 -125 (2003) |
|
