Haemostatic management for aortic valve replacement in a patient with advanced liver disease

Figure 1 Monitoring used for redo-stenotomy and aortic valve replacement. A: Cerebral oximeter (Invos, Somanetics^®); B: Bispectral index; C: 9 French Internal jugular sheath; D: Continuous cardiac output and mixed venous oximetry measured with a fiberoptic pulmonary artery catheter (Edwards Lifesciences, Irvine CA); E: 4-lumen central venous catheter.

Figure 2 Hepatic tissue oxygenation measured by positioning an oximetry disposable transducer between the ribs and over the liver. A: Hepatic oximeter (Invos, Somanetics).

Figure 3 Intraoperative continuous cardiac index and mixed venous oxygenations tracings measured from the pulmonary artery catheter displayed on a Vigilance™ Monitor (Edwards Lifesciences, Irvine CA). ICU: Intensive care unit; CPB: Cardiopulmonary bypass; CCI: Continuous cardiac index.

Figure 4 Cerebral and hepatic tissue oxygenation tracings measured with a cerebral/somatic oximeter (Invos Somanetics^®) throughout the surgery and during cardiopulmonary bypass. ICU: Intensive care unit; CPB: Cardiopulmonary bypass.

Figure 5 Perioperative thromboelastrography tracings observed in this case with corresponding haemostatic management action or planned strategy. DDAVP: Desmopressin acetate; FFP: Fresh frozen plasma; CPB: Cardiopulmonary bypass; TEG: Thromboelastography; TOE: Transoesophageal echocardiography; IV: Intravenous; ACT: Activated clotting time.