INDIVIDUAL STRATEGIES OF HEMOSTASIS FOR THORACIC AORTIC-SURGERY

The problem of altered hemostasis remains a major challenge during tho racic aortic surgery. Bleeding is associated with a marked increase in morbidity and mortality. The hemostatic derangements are caused by mu ltiple interrelated factors including interference with the vascular i ntegrity, extensive surgical dissection, transient need for complete i nhibition of the normal coagulation process, large blood products and fluid requirements, hemodilution, hypothermia, extensive ischemia and reperfusion, activation of systemic inflammatory responses, interferen ce with fibrinolysis, and the use of extracorporeal circulation system s. Acquired coagulopathy must be specifically diagnosed and treated. P latelet deficiencies, both qualitative and quantitative, are the most predictable and consistent disturbance in the hemostatic function and the most common cause of intraoperative and postoperative bleeding. Pr ecise surgical technique is essential to prevent blood loss. Topical a gents should not be used for and cannot correct imperfections in surgi cal technique. Nonspecific measurements that are useful to decrease in traoperative blood loss include strict control of blood pressure and h emodynamic status, the induction of mild controlled hypotension, and t he reversal of hypothermia. Rewarming may produce clear procoagulant e ffects by improving the efficacy of platelets and clotting factors. Pl atelet dysfunction can be reduced by several pharmacological intervent ions including acid aminocaproic, desmopressin and aprotinin; however, efficacy and safety are still being established. The most important f actors regarding safety in thoracic aortic surgery are a secure suture line and the experience of the surgical and anesthesiology teams.