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Articles by A Haverich
Total Records ( 3 ) for A Haverich
  T Bisdas , K. I Paraskevas , M Pichlmaier , M Wilhelmi , A Haverich and O. E. Teebken
 

The surgical approach-of-choice for the management of popliteal artery aneurysms (PAAs) remains controversial. We compared the results of the medial (MA) and dorsal (posterior) surgical approach (DA). Fifty patients (44 males/6 females; median age [range]: 59 [49-84] years) treated for 58 atherosclerotic PAAs were studied (MA: 29 PAAs; DA: 29 PAAs). The 3-year graft patency rates were higher after DA compared with MA (76% vs 52%, respectively), but the difference was not significant (P = .056). There were no differences between the 2 approaches in amputation, restenosis, reoperation, and wound infection rates. Dorsal approach and the MA may be alternative approaches with similar long-term results. Due to the controversial results reported so far, a meta-analysis may be necessary to establish the surgical approach-of-choice. Future studies should take into account additional factors, other than the surgical technique, when assessing outcome (eg, preoperative statin use, age, and emergency vs routine surgery).

  N Rahe Meyer , M Pichlmaier , A Haverich , C Solomon , M Winterhalter , S Piepenbrock and K. A. Tanaka
  Background

Bleeding diathesis after aortic valve operation and ascending aorta replacement (AV–AA) is managed with fresh-frozen plasma (FFP) and platelet concentrates. The aim was to compare haemostatic effects of conventional transfusion management and FIBTEM (thromboelastometry test)-guided fibrinogen concentrate administration.

Methods

A blood products transfusion algorithm was developed using retrospective data from 42 elective patients (Group A). Two units of platelet concentrate were transfused after cardiopulmonary bypass, followed by 4 u of FFP if bleeding persisted, if platelet count was ≤100x103 µl–1 when removing the aortic clamp, and vice versa if platelet count was >100x103 µl–1. The trigger for each therapy step was ≥60 g blood absorbed from the mediastinal wound area by dry swabs in 5 min. Assignment to two prospective groups was neither randomized nor blinded; Group B (n=5) was treated according to the algorithm, Group C (n=10) received fibrinogen concentrate (Haemocomplettan® P/Riastap, CSL Behring, Marburg, Germany) before the algorithm-based therapy.

Results

A mean of 5.7 (0.7) g fibrinogen concentrate decreased blood loss to below the transfusion trigger level in all Group C patients. Group C had reduced transfusion [mean 0.7 (range 0–4) u vs 8.5 (5.3) in Group A and 8.2 (2.3) in Group B] and reduced postoperative bleeding [366 (199) ml vs 793 (560) in Group A and 716 (219) in Group B].

Conclusions

In this pilot study, FIBTEM-guided fibrinogen concentrate administration was associated with reduced transfusion requirements and 24 h postoperative bleeding in patients undergoing AV–AA.

  A. L Meyer , D Malehsa , C Bara , U Budde , M. S Slaughter , A Haverich and M. Strueber
  Background—

Rotary blood pumps used as left ventricular assist devices (LVADs) allow for long-term support and may become suitable alternatives to heart transplantation. Effects of this technology on the coagulation system are not completely understood, leading to controversial anticoagulation protocols. Thus, we investigated the primary hemostasis in patients with chronic LVAD therapy.

Methods and Results—

Twenty-six outpatients received axial flow LVAD (HeartMate II; Thoratec) for a median support time of 4.5 months. In a cross-sectional protocol, platelet aggregation in response to ADP and epinephrine, von Willebrand antigen (vWF:AG), and collagen-binding capacity (vWF:CB) were obtained. Von Willebrand factor (vWF) multimer analyses were performed, and patients were screened for bleeding events. This analysis was repeated after removal of the device for transplantation or recovery (n=12) and after a median of 15.5 months in ongoing patients (n=11). In all patients on devices, severe impairment of platelet aggregation as well as a loss of large vWF multimers were found. In 10 patients, a decreased vWF:CB/vWF:AG ratio was observed. Bleeding episodes occurred with an incidence of 0.17 per patient-year. After removal of the device, normal patterns of platelet aggregation, multimer analysis, and vWF:CB/vWF:AG ratio were recorded. In the second analysis of ongoing patients, impairment of platelet aggregation and loss of large vWF multimers were verified.

Conclusions—

A diagnosis of von Willebrand syndrome type 2 was established in all patients after LVAD implantation, and bleeding events confirmed this finding. Reversibility of this condition was found after removal of the device.

 
 
 
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