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©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2014; 2(10): 596-603
Published online Oct 16, 2014. doi: 10.12998/wjcc.v2.i10.596
Published online Oct 16, 2014. doi: 10.12998/wjcc.v2.i10.596
Haemostatic management for aortic valve replacement in a patient with advanced liver disease
Laurence Weinberg, Irene Kearsey, Clarissa Tjoakarfa, Larry McNicol, Peter McCall, Department of Anaesthesia, Austin Hospital, Melbourne, Victoria 3084, Australia
George Matalanis, Sean Galvin, Scott Carson, Department of Cardiac Surgery, Austin Hospital, Melbourne, Victoria 3084, Australia
Rinaldo Bellomo, Department of Intensive Care, Austin Hospital, Melbourne, Victoria 3084, Australia
Author contributions: Weinberg L and McCall P were the principal anaesthetists who managed the case; both were responsible for the planning and writing of the case report; Kearsey I and Tjoakarfa C were responsible for all the data collection, collation of pictures and the writing of the case report; Matalanis G and Galvin S were the cardiac surgeons that performed the operation and were responsible for the writing of the case report; Carson S was the clinical perfusionist that managed the case and was responsible for the writing of the case report; McNicol L and Bellomo R were responsible for the co-management of the patient in the preoperative and postoperative period and were responsible for the writing of the manuscript.
Supported by Department of Anaesthesia Research Fund, Department of Anaesthesia, Austin Hospital, Melbourne, Victoria 3084, Australia
Correspondence to: Laurence Weinberg, MBBCH, BSc, MRCP, DipCritCareECho, FANZCA, Department of Anaesthesia, Austin Hospital, 145 Studley Rd, Melbourne, Victoria 3084, Australia. laurence.weinberg@austin.org.au
Telephone: +61-3-94965000 Fax: +61-3-94965000
Received: May 23, 2014
Revised: June 26, 2014
Accepted: July 25, 2014
Published online: October 16, 2014
Processing time: 145 Days and 2.9 Hours
Revised: June 26, 2014
Accepted: July 25, 2014
Published online: October 16, 2014
Processing time: 145 Days and 2.9 Hours
Core Tip
Core tip: Cardiac surgery in patients with advanced liver disease is associated with significant morbidity and mortality. Refractory coagulopathy is common and requires a proactive multidisciplinary haemostatic management strategy. Given the limited information available for the specific management and prevention of cardiopulmonary bypass induced haemostatic failure, this report serves to guide the anaesthesia and medical management of future cases of a similar kind. We discuss our multimodal management of haemostatic failure using pharmacological strategies, thromboelastography, continuous cerebral and liver oximetry, and continuous cardiac output monitoring.