CONTROL AND TREATMENT OF HEMOSTASIS IN CARDIOVASCULAR-SURGERY - THE EXPERIENCE OF LA-PITIE-HOSPITAL WITH PATIENTS ON TOTAL ARTIFICIAL-HEART

The hemostasis protocol applied at the Cardiovascular Surgery Dept. of La Pitie Hospital has greatly reduced thromboembolic accidents and ex cessive bleeding, with consequent benefits for patients as well as cos t reduction. Protocol also has been adopted for patients implanted wit h a circulatory assist device or a TAH. This paper presents our criter ia on supervision and treatment of coagulation with such patients, who reflect all the acquired pathology in clinical hemostasis. From 04/86 to 07/94, 82 patients underwent TAH as a bridge to transplantation. M ean age: 38. Overall duration of mechanical support: 1930 days (mean: 23), of which 137 and 603 for 2 patients. Average duration of CPB: 150 min. Systematic approach to complex TAH-blood interaction and pre-ope rative multiple organ dysfunction used to control bleeding and/or thro mboembolism after CPB. In addition to routine tests, specific regular testing was carried out at least once a day for platelet functions, fo r thrombin formation and its regulatory pathways, and for the fibrinol ytic system. Patients were treated with small doses of Heparin, large doses of Dypyridamole, small doses of Aspirin, modulated doses of Apro tinin, Ticlopidine, Pentoxifylline, FFP, as well as Fibrinogen and ATI II concentrates. Dosage was adapted to patient's clinical profile as w ell as to test interpretation criteria to provide personalized treatme nt. DIG, widely present in its different phases, was thus diagnosed an d treated. All DIC bleeding was controlled, making it possible to dete ct other causes of post-operatory bleeding and use blood derivates rat ionally. There were no thromboembolic complications and no iatrogenic bleeding. TAH explantation shows no evidence of macroscopic clots in h igh risk sites, confirmed by microscopic analysis.