1Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, Korea
2Department of Anesthesiology and Pain Medicine, Sejong General Hospital, Bucheon, Korea
3Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea
Copyright © 2016 The Korean Society of Critical Care Medicine
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Variables | JW group (n = 25) | non-JW group (n = 25) | p* |
---|---|---|---|
Age (years) | 54.0 ± 11.5 | 54.1 ± 11.5 | 0.993 |
Female | 18 (72.0%) | 18 (72.0%) | 1.000 |
NYHA functional class | 2.6 ± 0.8 | 2.6 ± 0.6 | 1.000 |
DM | 2 (8.0%) | 2 (8.0%) | 1.000 |
Hypertension | 5 (20.0%) | 5 (20.0%) | 1.000 |
CVA | 1 (4.0%) | 2 (8.0%) | 1.000 |
Hyperlipidemia | 3 (12.0%) | 5 (20.0%) | 0.702 |
Peripheral artery disease | 1 (4.0%) | 0 (0.0%) | 1.000 |
Atrial fibrillation | 10 (40.0%) | 6 (24.0%) | 0.364 |
Preop EF (%) | 62.8 ± 7.9 | 59.4 ± 12.8 | 0.253 |
Operated valve | |||
Aortic | 11 (44.0%) | 15 (60.0%) | 0.396 |
Mitral | 17 (68.0%) | 16 (64.0%) | 1.000 |
Tricuspid | 10 (40.0%) | 4 (16.0%) | 0.114 |
Multiple valve surgery | 11 (44.0%) | 7 (28.0%) | 0.377 |
Valve replacement | 18 (72.0%) | 21 (84.0%) | 0.496 |
Mechanical valve | 15 (60.0%) | 16 (64.0%) | 1.000 |
Concomitant procedures | 9 (36.0%) | 7 (28.0%) | 0.762 |
Maze procedure | 8 | 17 | |
Ascending aorta replacement | 1 | 1 | |
ASD closure | 0 | 1 | |
CPB time (min) | 133.3 ± 35.6 | 130.8 ± 34.1 | 0.799 |
ACC time (min) | 100.3 ± 30.0 | 96.3 ± 27.9 | 0.628 |
Acute normovolemic hemodilution | 6 (24.0%) | 3 (12.0%) | 0.463 |
Blood cardioplegia | 18 (72.0%) | 19 (76.0%) | 1.000 |
Emergency or urgency | 1 (4.0%) | 0 (0.0%) | 1.000 |
Perioperative transfusion | 0 (0.0%) | 22 (88.0%) | < 0.000 |
Data are presented as mean ± standard deviation, or number (%). Tricuspid valve procedures were all concomitantly performed with other valve procedures, except one case in the JW group.
*Student’s t test for continuous variables, Fisher’s exact test for categorical variables.
JW: Jehovah’s Witnesses; NYHA: New York Heart Association; DM: diabetes mellitus; CVA: cerebrovascular accident; ASD: atrial septal defect; EF: ejection fraction; CPB: cardiopulmonary bypass; ACC: aortic cross-clamping.
Variables | JW group (n = 25) | non-JW group (n = 25) | p* |
---|---|---|---|
Operative death | 1 (4.0%) | 0 (0.0%) | 1.000 |
Postoperative complications | 7 (28.0%) | 7 (28.0%) | 1.000 |
LV dysfunction | 2 | 2 | |
RV failure | 1 | 0 | |
IABP support | 0 | 2 | |
Arrhythmia | 1 | 2 | |
Renal failure or insufficiency | 3 | 1 | |
Sternal wound infection | 2 | 1 | |
Re-sternotomy bleeding control | 0 | 1 | |
Gastrointestinal bleeding | 0 | 1 | |
Postop length of stay (days) | 20.2 ± 13.3 | 16.7 ± 6.5 | 0.252 |
Postop EF (%) | 56.6 ± 10.9 | 56.1 ± 11.5 | 0.866 |
(pre–post) difference of EF (%) | 6.2 ± 11.0 | 3.3 ± 9.1 | 0.309 |
Late mortality | 3 | 1 | 0.313 |
Late morbidity | 5 | 5 | 0.885 |
Bleeding | 1 | 2 | |
Embolism | 1 | 1 | |
Reintervention | 2 | 0 | |
Congestive heart failure | 1 | 2 | |
Arrhythmia | 0 | 2 | |
Late valve-related morbidity | 4 | 3 | 0.625 |
Data are presented as mean ± standard deviation, or number (%).
*Student’s t test for continuous variables, Fisher’s exact test for categorical variables, log-rank test in survival curve by Kaplan-Meier method for late outcomes.
JW: Jehovah’s Witnesses; LV: left ventricle; RV: right ventricle; IABP: intra-aortic balloon pump; EF: ejection fraction.
Variables | JW group (n = 25) | non-JW group (n = 25) | p* |
---|---|---|---|
Preop Hb (g/dL) | 13.0 ± 1.5 | 13.2 ± 1.4 | 0.705 |
Postop Hb (g/dL) | 11.7 ± 1.6 | 12.2 ± 1.7 | 0.273 |
(pre–post) difference of Hb (g/dL) | 1.3 ± 1.3 | 0.9 ± 1.9 | 0.414 |
Preop Hct (%) | 38.9 ± 3.9 | 39.0 ± 3.7 | 0.936 |
Lowest Hct during CPB (%) | 23.3 ± 2.5 | 22.8 ± 2.2 | 0.511 |
Postop Hct (%) | 35.2 ± 5.1 | 35.9 ± 4.7 | 0.639 |
(pre–post) difference of Hct (%) | 3.7 ± 4.0 | 3.1 ± 5.4 | 0.677 |
(pre–CPB) difference of Hct (%) | 15.6 ± 3.5 | 16.1 ± 3.3 | 0.584 |
Preop Cr (mg/dL) | 0.96 ± 0.30 | 0.88 ± 0.25 | 0.292 |
Postop Cr (mg/dL) | 1.23 ± 0.43 | 1.11 ± 0.38 | 0.289 |
(post–pre) difference of Cr (mg/dL) | 0.27 ± 0.28 | 0.22 ± 0.27 | 0.600 |
Variables | JW group (n = 25) | non-JW group (n = 25) | p |
---|---|---|---|
Age (years) | 54.0 ± 11.5 | 54.1 ± 11.5 | 0.993 |
Female | 18 (72.0%) | 18 (72.0%) | 1.000 |
NYHA functional class | 2.6 ± 0.8 | 2.6 ± 0.6 | 1.000 |
DM | 2 (8.0%) | 2 (8.0%) | 1.000 |
Hypertension | 5 (20.0%) | 5 (20.0%) | 1.000 |
CVA | 1 (4.0%) | 2 (8.0%) | 1.000 |
Hyperlipidemia | 3 (12.0%) | 5 (20.0%) | 0.702 |
Peripheral artery disease | 1 (4.0%) | 0 (0.0%) | 1.000 |
Atrial fibrillation | 10 (40.0%) | 6 (24.0%) | 0.364 |
Preop EF (%) | 62.8 ± 7.9 | 59.4 ± 12.8 | 0.253 |
Operated valve | |||
Aortic | 11 (44.0%) | 15 (60.0%) | 0.396 |
Mitral | 17 (68.0%) | 16 (64.0%) | 1.000 |
Tricuspid | 10 (40.0%) | 4 (16.0%) | 0.114 |
Multiple valve surgery | 11 (44.0%) | 7 (28.0%) | 0.377 |
Valve replacement | 18 (72.0%) | 21 (84.0%) | 0.496 |
Mechanical valve | 15 (60.0%) | 16 (64.0%) | 1.000 |
Concomitant procedures | 9 (36.0%) | 7 (28.0%) | 0.762 |
Maze procedure | 8 | 17 | |
Ascending aorta replacement | 1 | 1 | |
ASD closure | 0 | 1 | |
CPB time (min) | 133.3 ± 35.6 | 130.8 ± 34.1 | 0.799 |
ACC time (min) | 100.3 ± 30.0 | 96.3 ± 27.9 | 0.628 |
Acute normovolemic hemodilution | 6 (24.0%) | 3 (12.0%) | 0.463 |
Blood cardioplegia | 18 (72.0%) | 19 (76.0%) | 1.000 |
Emergency or urgency | 1 (4.0%) | 0 (0.0%) | 1.000 |
Perioperative transfusion | 0 (0.0%) | 22 (88.0%) | < 0.000 |
Phase | Objective | Contents |
---|---|---|
Preoperative | Maintenance | Discontinue intake of alcohol, and medications or supplements that may increase bleeding risk |
Withdrawal of aspirin (3 to 5 days before operation) and clopidogrel (7 days before operation) | ||
Conversion warfarin to unfractionated heparin | ||
Reduced laboratory sampling | ||
Reinforcement | Subcutaneous erythropoietin (500 units/kg per day, every-other-day) as indicated, toward goal hemoglobin of 13 g/dL (male) or 12 g/dL (female) | |
Supplement of iron, folate, calcium, vitamin C | ||
Intraoperative | Maintenance | Hyperoxic ventilation |
Hypotensive anesthesia | ||
Low-volume acute normovolemic hemodilution; volume target to Hb 10 g/dL and simultaneous replacement of same volume colloid solution | ||
Hemostatic operative technique | ||
Reduced laboratory sampling | ||
Reinforcement | Cell salvage and re-transfusion using a cell saving device | |
CPB | Maintenance | Minimum volume in cardiopulmonary bypass circuit |
Retrograde autologous priming | ||
Reinforcement | Modified ultrahemofiltration | |
Postoperative | Maintenance | Anticoagulants including tranexamic acid |
Reduced laboratory sampling | ||
Reinforcement | Shed mediastinal and pleural blood reinfusion using a cell saving device | |
Preoperative drugs re-use (erythropoietin, iron, folate, calcium, vitamin C) |
Variables | JW group (n = 25) | non-JW group (n = 25) | p |
---|---|---|---|
Operative death | 1 (4.0%) | 0 (0.0%) | 1.000 |
Postoperative complications | 7 (28.0%) | 7 (28.0%) | 1.000 |
LV dysfunction | 2 | 2 | |
RV failure | 1 | 0 | |
IABP support | 0 | 2 | |
Arrhythmia | 1 | 2 | |
Renal failure or insufficiency | 3 | 1 | |
Sternal wound infection | 2 | 1 | |
Re-sternotomy bleeding control | 0 | 1 | |
Gastrointestinal bleeding | 0 | 1 | |
Postop length of stay (days) | 20.2 ± 13.3 | 16.7 ± 6.5 | 0.252 |
Postop EF (%) | 56.6 ± 10.9 | 56.1 ± 11.5 | 0.866 |
(pre–post) difference of EF (%) | 6.2 ± 11.0 | 3.3 ± 9.1 | 0.309 |
Late mortality | 3 | 1 | 0.313 |
Late morbidity | 5 | 5 | 0.885 |
Bleeding | 1 | 2 | |
Embolism | 1 | 1 | |
Reintervention | 2 | 0 | |
Congestive heart failure | 1 | 2 | |
Arrhythmia | 0 | 2 | |
Late valve-related morbidity | 4 | 3 | 0.625 |
Variables | JW group (n = 25) | non-JW group (n = 25) | p |
---|---|---|---|
Preop Hb (g/dL) | 13.0 ± 1.5 | 13.2 ± 1.4 | 0.705 |
Postop Hb (g/dL) | 11.7 ± 1.6 | 12.2 ± 1.7 | 0.273 |
(pre–post) difference of Hb (g/dL) | 1.3 ± 1.3 | 0.9 ± 1.9 | 0.414 |
Preop Hct (%) | 38.9 ± 3.9 | 39.0 ± 3.7 | 0.936 |
Lowest Hct during CPB (%) | 23.3 ± 2.5 | 22.8 ± 2.2 | 0.511 |
Postop Hct (%) | 35.2 ± 5.1 | 35.9 ± 4.7 | 0.639 |
(pre–post) difference of Hct (%) | 3.7 ± 4.0 | 3.1 ± 5.4 | 0.677 |
(pre–CPB) difference of Hct (%) | 15.6 ± 3.5 | 16.1 ± 3.3 | 0.584 |
Preop Cr (mg/dL) | 0.96 ± 0.30 | 0.88 ± 0.25 | 0.292 |
Postop Cr (mg/dL) | 1.23 ± 0.43 | 1.11 ± 0.38 | 0.289 |
(post–pre) difference of Cr (mg/dL) | 0.27 ± 0.28 | 0.22 ± 0.27 | 0.600 |
Data are presented as mean ± standard deviation, or number (%). Tricuspid valve procedures were all concomitantly performed with other valve procedures, except one case in the JW group. Student’s JW: Jehovah’s Witnesses; NYHA: New York Heart Association; DM: diabetes mellitus; CVA: cerebrovascular accident; ASD: atrial septal defect; EF: ejection fraction; CPB: cardiopulmonary bypass; ACC: aortic cross-clamping.
CPB: cardiopulmonary bypass.
Data are presented as mean ± standard deviation, or number (%). Student’s JW: Jehovah’s Witnesses; LV: left ventricle; RV: right ventricle; IABP: intra-aortic balloon pump; EF: ejection fraction.
Data are presented as mean ± standard deviation. Student’s JW: Jehovah’s Witnesses ; Hb: hemoglobin; Hct: hematocrit; CPB: cardiopulmonary bypass; Cr: serum creatinine.