A 50-year-old female underwent surgery for removal of a massive retroperitoneal sarcoma (RPS) involving the right hepatic lobe and the inferior vena cava (IVC), abdominal aorta, right lung, right hemi-diaphragm and pericardium. Resection of the RPS necessitated cross-clamping of the abdominal aorta, IVC and the hepatic artery. Cross-clamp time cannot be predicted prior to tumour resection and vascular re-construction. To prevent complications of prolonged cross-clamp time and distal hypo-perfusion, circulatory support was sought to facilitate the procedure. A perfusion circuit was designed to accommodate an easy and immediate redirection of blood flow from venovenous bypass (VVB) to veno-arterial bypass (VAB) without requiring a change of circuit and with minimum heparin administration. Furthermore, this circuit provides the added safety of an oxygenator and a heat-exchanger. Utilising the circuit enabled successful resection of the RPS. The patient was discharged from the intensive care unit (ICU) seven days later without any post-operative complications. This case report of a design of a perfusion circuit for the resection of RPS made use of a perfusion approach that had not previously been described and allowed for a reduction in the duration of ischaemic time and retroperitoneal bleeding.

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The manufacturer of the ACT Plus® Automated Coagulation Timer, Medtronic Inc., recommends that test cartridges be prewarmed and the activating reagent resuspended (tapped/mixed) before patient testing. In a busy clinical environment, these recommendations may be overlooked or disregarded. In this study, the impact of sampling technique on ACT Plus® test results was investigated. In Series 1, two test cartridges were split into four individual chambers. Two ACT Plus® machines were used, allowing for three separate comparisons to be made. The sample results from test Chambers 2 (cold/tapped), 3 (warmed/not tapped), and 4 (cold/not tapped) were compared individually against the result from test Chamber 1, the recommended technique (warm/tapped). In Series 2, the manufacturer’s recommendations were tested using a single double cartridge (warm/tapped). Results were interpreted using the Bland-Altman method of analysis. The prewarming and tapping of cartridges before use independently influenced the agreement of results when compared with cartridges that were not prewarmed and tapped. Each factor (temperature and mixing) when excluded was found to affect the standard deviation and decrease the agreement of results. By following the manufacturer’s recommendations to standardize the sampling technique, ACT Plus® test results are more accurate.

Abstracts S385nance of competence programs for this kind of surgery in Australia.http://dx.

Seizures following cardiopulmonary bypass are an immediate and alarming indication that a neurologic event has occurred. A case report of a 67-year-old man undergoing aortic valve surgery who unexpectedly experiences seizures following cardiopulmonary bypass is outlined. Possible contributing factors including atheromatous disease in the aorta, low cerebral perfusion pressures, an open-chamber procedure, and the use of tranexamic acid are identified.