Research Article
Predictive Value of Thromboelastography for Postoperative Blood Loss in Infants Undergoing Cardiac Surgery
Yuan Yuan*
Issue:
Volume 10, Issue 2, April 2024
Pages:
14-18
Received:
19 May 2024
Accepted:
5 June 2024
Published:
26 June 2024
Abstract: Thromboelastography (TEG) has emerged as a critical tool in promptly identifying the risk of postoperative bleeding, especially in infants and young children undergoing cardiac surgery. By meticulously analyzing TEG parameters, clinicians gain a profound understanding of patients' coagulation status, enabling timely intervention to minimize and manage postoperative bleeding risks. The present study adopts a rigorous, prospective, and observational approach to explore the relationship between intraoperative TEG test results and postoperative blood loss. Furthermore, it aims to assess the potential of intraoperative TEG testing as an early predictor of postoperative bleeding in high-risk pediatric patients. In this process, a key focus is placed on perioperative red blood cell suspension and platelet transfusion volume, as well as their association with TEG testing outcomes. Our findings reveal a significant correlation between the volume of red blood cell suspension and platelet transfusion and the MA value derived from TEG testing. The MA value, a pivotal indicator in TEG test results, represents the maximum clotting strength. Notably, during perioperative red blood cell suspension and platelet transfusion, the MA value often exhibits corresponding changes. These changes not only reflect improvements in coagulation function but also provide clinicians with an objective basis for evaluating the effectiveness of blood transfusion. However, despite the notable impact of blood transfusion on MA values, our study did not detect statistically significant associations between blood transfusion and other TEG parameters, including TEG-ACT values, α-Angle, and LY30. This absence of significant associations may be attributed to the differential effects of various transfusion components on the coagulation process, as well as the influence of confounding factors such as patient age, comorbidities, and surgical procedure type.
Abstract: Thromboelastography (TEG) has emerged as a critical tool in promptly identifying the risk of postoperative bleeding, especially in infants and young children undergoing cardiac surgery. By meticulously analyzing TEG parameters, clinicians gain a profound understanding of patients' coagulation status, enabling timely intervention to minimize and man...
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Research Article
Shorten τ1 in Chronic Early vs. Late Systolic LV Load for Systolic Dysfunction in Ascending vs. Descending Thoracic Aortic Stenosis
Issue:
Volume 10, Issue 2, April 2024
Pages:
19-28
Received:
13 February 2024
Accepted:
1 March 2024
Published:
23 July 2024
Abstract: Background: Arterial hypertension (HTA) results with diastolic LV dysfunction (DD), important to develop systolic LV dysfunction and exercise intolerance with HF. Separating between chronic late (LL) to early LV load (EL) during systole, impaired LV relaxation is present earlier in chronic LL vs. EL, having early HF, as result of myocardial ischemia and systolic LV dysfunction in HTA. Objective and Methods: to assess early systolic in diastolic LV dysfunction from biexponential τ regression assessment, using single beat and mono-exponential regression analysis, with nonzero asymptote with special software in LL and EL, between 4th and 8th week in a porcine model. This assesses early HF and systolic LV pump dysfunction, from fast_τ (τ1), for early systolic LV dysfunction, in LVH remodeling in moderate LV afterload increase. Fourteen domestic male pigs, underwent LV pressure measurements with conductance Millar 5F catheter having moderate ascending aortic banding (EL=6), and in descending thoracic aortic stenosis, as in hypertension (LL=8). τ1 (τ_fast) and τ2 (for τ_slow) component of bi-exponential τ analyzed LV dysfunction at 4th vs. 8th week. Under reduced LV load (m3), during ventilation preserved (m1) or suspended transitionally (m2), fast τ assess early systolic dysfunction in LL vs. EL. Associated murmurs were assessed to detect LV valves dysfunction. Data was compared statistically, using two-way repeated measurement ANOVA, after Leven normality test. Results are means±SEM or medians (quartiles), for significant p<0.05. Results: mono-exponential τ was not different, neither changed in LL vs. EL at 4th and 8th week in m1, m2 or m3, that reduced in both groups with mechanical LV load reduction at 4th and 8th week (p<0.05). Prolonged bi-exponential asynchronous τ2/τ1 ratio in EL was different from LL at 8th week, resulted from LV afterload (τ2τ1 interaction p<0.05). τ_fast was different, being shorten in EL vs. LL at 4th and 8th week. Reduced bi-exponential τ2τ1 ratio in EL and increased in LL, with mechanical load reduction, improved LV ischemia with DD in EL at 4th and 8th week of moderate LV afterload increase, but did not respond in LL. There was predominant systolic murmur in EL and diastolic murmur in LL, pronounced with load reduction. Conclusion: Prolonged bi-exponential τ1 in LL shows early systolic LV dysfunction within DD. LV ischemia and systolic with diastolic LV pump dysfunction in EL presents shorten fast_τ, being unresponsive to mechanical LV load reduction in LL.
Abstract: Background: Arterial hypertension (HTA) results with diastolic LV dysfunction (DD), important to develop systolic LV dysfunction and exercise intolerance with HF. Separating between chronic late (LL) to early LV load (EL) during systole, impaired LV relaxation is present earlier in chronic LL vs. EL, having early HF, as result of myocardial ischemi...
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