scholarly journals Anticoagulation with Argatroban in a Patient with Heparin-Induced Thrombocytopenia and Renal Insufficiency Undergoing Orthotopic Heart Transplantation

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Michael Stuart Green ◽  
Johann Mathew ◽  
Christopher Ryan Hoffman ◽  
Henry Liu
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Transplantation ◽  
Decompensated Heart Failure ◽  
Orthotopic Heart Transplantation ◽  
Clinical Use ◽  
Heparin Induced Thrombocytopenia ◽  
Advantages And Disadvantages ◽  
Immune Mediated

Unfractionated heparin is the anticoagulant of choice for cardiac surgery that requires cardiopulmonary bypass. However, it can cause serious side effects like heparin-induced thrombocytopenia (HIT), an immune-mediated process where antibodies are directed against heparin and platelet 4 complexes. In such cases, alternative pharmacologic strategies are implemented to facilitate safe bypass conditions. A woman with severe decompensated heart failure was heparinized for intra-aortic balloon pump and subsequent LVAD placement. On day 6, a fall in platelets from 113,000 to 26,000 was noted. She was diagnosed with HIT. Heparin was discontinued and replaced with an argatroban infusion for the duration of her care until heart transplantation was completed. We review the mechanism, diagnosis, and complications of HIT. We discuss cardiopulmonary bypass and its relation to heparin, HIT, and heparin alternatives. We discuss argatroban’s relevant pharmacology, clinical use, advantages, and disadvantages.

scholarly journals GTH 2021 State of the Art—Cardiac Surgery: The Perioperative Management of Heparin-Induced Thrombocytopenia in Cardiac Surgery

2021 ◽  
Vol 41 (01) ◽  
pp. 059-062
Author(s):  
Laura Ranta ◽  
Emmanuelle Scala
Keyword(s):  
Adverse Drug Reaction ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Multidisciplinary Approach ◽  
Perioperative Management ◽  
State Of The Art ◽  
Short Review ◽  
Prothrombotic State ◽  
Heparin Induced Thrombocytopenia ◽  
Immune Mediated

AbstractHeparin-induced thrombocytopenia (HIT) is a severe, immune-mediated, adverse drug reaction that paradoxically induces a prothrombotic state. Particularly in the setting of cardiac surgery, where full anticoagulation is required during cardiopulmonary bypass, the management of HIT can be highly challenging, and requires a multidisciplinary approach. In this short review, the different perioperative strategies to run cardiopulmonary bypass will be summarized.

Total 12-Lead QRS Voltage in Patients Having Orthotopic Heart Transplantation for Heart Failure Caused by Adriamycin-Induced Cardiomyopathy

Cardiology ◽  
2018 ◽  
Vol 141 (3) ◽  
pp. 172-175 ◽  
Author(s):  
William C. Roberts ◽  
Sarah Haque ◽  
Shelley A. Hall
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Cardiac Amyloidosis ◽  
Cardiac Sarcoidosis ◽  
Medical Center ◽  
Severe Heart Failure ◽  
Orthotopic Heart Transplantation ◽  
S Wave ◽  
Baylor University ◽  
Before And After

Objective: Although several studies have described the effects of adriamycin on the heart, electrocardiographic total 12-lead QRS voltage (distance in millimeters from the peak of the R wave to the nadir of either the Q or S wave, whichever was deeper, with 10 mm [1 mV] being standard) both before and after orthotopic heart transplantation (OHT) has not been reported. This study describes the total 12-lead QRS voltage in 8 patients studied at Baylor University Medical Center at Dallas, from 1994 to June 2018, who underwent OHT for severe heart failure caused by anthracycline-induced cardiomyopathy. Method: Prior to OHT, the total 12-lead non-paced QRS voltages ranged from 86 to 189 mm (mean 125 ± 56) and for paced QRS voltages from 82 to 113 mm (mean 97 ± 15). The total 12-lead QRS voltages post-OHT ranged from 100 to 190 mm (mean 130 ± 30). Total 12-lead QRS voltages were lower in patients with a pacemaker than without. Results/Conclusion: These low voltages are like those found in patients with carcinoid syndrome, severe cardiac adiposity, cardiac amyloidosis, and cardiac sarcoidosis.

The Obstetric Patient for Cardiac Surgery

2019 ◽  
pp. 335-340
Author(s):  
Lauren Powlovich ◽  
Amanda M. Kleiman
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Disease ◽  
Medical Management ◽  
Heart Defects ◽  
Pregnant Patient ◽  
Developed Countries ◽  
Peripartum Hemorrhage ◽  
In Pregnancy

Cardiac disease is the second leading cause of morbidity and mortality in pregnancy behind peripartum hemorrhage. In developed countries, a majority of cardiac disease in pregnancy is secondary to congenital heart defects, whereas in developing countries, mitral stenosis secondary to rheumatic fever prevails as the leading cause of cardiac disease during pregnancy. There is added workload on the heart during pregnancy due to the increased blood volume and cardiac output of the parturient. In patients with preexisting cardiac disease, this added workload may lead to decompensated congestive heart failure. Alternatively, such physiologic changes may unmask an unknown cardiac lesion in an unsuspecting patient. Medical management is always the first-line treatment of the pregnant patient with decompensated heart failure. However, if medical management has failed, cardiac surgery with cardiopulmonary bypass may be necessary. Due to the unique maternal physiology and the presence of not only one but also two patients, anesthesia, cardiac surgery, and cardiopulmonary bypass come with specific challenges, hemodynamic goals, and ethical dilemmas.

scholarly journals Vasoresponsiveness in patients with heart failure (VASOR): protocol for a prospective observational study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Marieke E. van Vessem ◽  
Saskia L. M. A. Beeres ◽  
Rob B. P. de Wilde ◽  
René de Vries ◽  
Remco R. Berendsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Observational Study ◽  
Vascular Reactivity ◽  
Prospective Observational Study ◽  
Ex Vivo ◽  
Phase 1 ◽  
Resistance Arteries ◽  
Patients With Heart Failure

Abstract Background Vasoplegia is a severe complication which may occur after cardiac surgery, particularly in patients with heart failure. It is a result of activation of vasodilator pathways, inactivation of vasoconstrictor pathways and the resistance to vasopressors. However, the precise etiology remains unclear. The aim of the Vasoresponsiveness in patients with heart failure (VASOR) study is to objectify and characterize the altered vasoresponsiveness in patients with heart failure, before, during and after heart failure surgery and to identify the etiological factors involved. Methods This is a prospective, observational study conducted at Leiden University Medical Center. Patients with and patients without heart failure undergoing cardiac surgery on cardiopulmonary bypass are enrolled. The study is divided in two inclusion phases. During phase 1, 18 patients with and 18 patients without heart failure are enrolled. The vascular reactivity in response to a vasoconstrictor (phenylephrine) and a vasodilator (nitroglycerin) is assessed in vivo on different timepoints. The response to phenylephrine is assessed on t1 (before induction), t2 (before induction, after start of cardiotropic drugs and/or vasopressors), t3 (after induction), t4 (15 min after cessation of cardiopulmonary bypass) and t5 (1 day post-operatively). The response to nitroglycerin is assessed on t1 and t5. Furthermore, a sample of pre-pericardial fat tissue, containing resistance arteries, is collected intraoperatively. The ex vivo vascular reactivity is assessed by constructing concentrations response curves to various vasoactive substances using isolated resistance arteries. Next, expression of signaling proteins and receptors is assessed using immunohistochemistry and mRNA analysis. Furthermore, the groups are compared with respect to levels of organic compounds that can influence the cardiovascular system (e.g. copeptin, (nor)epinephrine, ANP, BNP, NTproBNP, angiotensin II, cortisol, aldosterone, renin and VMA levels). During inclusion phase 2, only the ex vivo vascular reactivity test is performed in patients with (N = 12) and without heart failure (N = 12). Discussion Understanding the difference in vascular responsiveness between patients with and without heart failure in detail, might yield therapeutic options or development of preventive strategies for vasoplegia, leading to safer surgical interventions and improvement in outcome. Trial registration The Netherlands Trial Register (NTR), NTR5647. Registered 26 January 2016.

Incidence and Outcomes of Cardiac Surgery After Orthotopic Heart Transplantation

2018 ◽  
Vol 37 (4) ◽  
pp. S432-S433
Author(s):  
M.T. Simpson ◽  
H. Takayama ◽  
J. Han ◽  
P. Kurlansky ◽  
A.R. Garan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Transplantation ◽  
Orthotopic Heart Transplantation
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