Coagulation Control Made in Fifteen Recipients of Jarvik 7 Artificial Heart. An Statistical Study

Abstract

From April to December of 1986 fifteen Jarvik-7 artifi cial heart were temporally implanted until definitive-heart transplantation in 12 men and 3 women of 18 to 55 years old.Jarvik's stay ranged between 48 hours to 20 days, The coagulation control applied was:PT,APTT, reptilase,fibrinogen,platelet aggregation by turbidi-metry to ADP,epinephrine,collagen and arachidonic acid thromboelastography in whole blood,plasma and serum antithrombin III and activated factor X by specific substrates,haematocrit, platelet count,platelet factor 4 and B-thromboglobulin by enzymeimmunoassays,fibrin/ fibrinogen degradation products,alfa-2-antiplasmin, fibrinopeptide A and Raby’s transference test.Number of controls for each patient were 1 to 3 daily.Measure ments were done in preoperative,immediate postoperative and maxim bleeding period.The most significant data were compiled in tables as number of cases, x ± S.E. and S.D.x.Statistical methods were correlation coeffic ient, Pares “t”and Newman-Keuls for p <0.05. It is concluded that the most critical period was the immediate postoperative and because of the treatments applied in the maxim bleeding period, it was possible to reach the patient’s healtn recuperation whenever either a se vere organic failure or sepsis did not appear.Treatments mainly applied were heparin,dipyridamol,aproti-nin and antithrombin III concentrates, dose being adag ted to the results obtained in controls.Jarvik’s status observations when explanted will be presented in a paper aside.No patient suffered any cerebral,vascular or thromboembolic event.

Left Centrifugal Pump Cardiac Assist with Transseptal Percutaneous Left Atrial Cannula

“…For all the other cardiac patients operated on in our unit, we have used our multisystem coagulation treatment (proposed by J. Szefner) ( Table 3). This system was developed based on the general idea that complex cardiac assist and blood interface require a systematic and personalized approach to avoid thromboembolic complications ( 9–10) with control of platelet function, thrombin formation pathways, and fibrinolytic status. If a pathological fibrinolytic state has been found, aprotinin has been given until normalization.…”