Thoracic aortic surgery in Europe: Does volume mean necessarily quality?

Off-pump coronary artery bypass grafting using continuous heparin infusion

“…Longer ACT (more than 350 seconds) is avoided during PCI as it does not increase stent patency rate but increases bleeding complications. Similarly in DOOR study, ACT more than 400 seconds in the OPCAB group may have caused increased bleeding without improving graft patency 8, 9. It may be concluded that ACT less than 350 seconds (between 200 and 300 seconds) may be optimal for OPCAB with least incidence of postoperative myocardial infarction and minimal intra-operative blood loss 12…”

“…In DOOR study, ACT longer than 400 seconds was maintained in OPCAB group and may have resulted in higher rate of vein graft failure due to paradoxical platelet activation 8 . Prolonged ACT increases blood loss during OPCAB without improving graft patency 9 . The physiology of OPCAB is different from coronary artery bypass grafting using cardiopulmonary bypass and probably similar to PCI 12…”

“…So the normal response to a lower ACT is to supplement a higher dose of bolus heparin. Higher dose of heparin may increase the heparin half life with increase of ACT above 350 seconds with detrimental effects on graft patency due to platelet activation 8, 9, 12…”

“…ACT more than 400 seconds was maintained in OPCAB group in recently published Danish off-pump versus on on-pump revascularization (DOOR) study. It was concluded by the authors of DOOR study that higher level of anticoagulation during OPCAB may result in increased bleeding without improving graft patency 8, 9…”

Venoarterial Extracorporeal Membrane Oxygenation After Surgical Repair of Type A Aortic Dissection

“…This finding is of relevance since the use of intraaortic balloon pump is contraindicated in those who underwent TAAD repair who develop PCS due to the coexistence of descending thoracic and abdominal aorta dissection. 7,12,13 Therefore, in this cohort of patients, VA-ECMO is the only temporary circulatory support strategy available.…”