Department of Cardiovascular Surgery, Okinawa Nanbu Prefectural Medical Center and Children's Medical Center, 118-1, Aza-arakawa, Haebaru-cho, Shimajiri-gun, Okinawa, 901-1193, Japan.
Department of Clinical Engineering, Okinawa Nanbu Prefectural Medical Center and Children's Medical Center, Okinawa, Japan.
Gen Thorac Cardiovasc Surg. 2022 Jul;70(7):602-610. doi: 10.1007/s11748-021-01743-w. Epub 2021 Nov 23.
We present a novel strategy in cardiac surgery with a cardiopulmonary bypass with low-dose heparin and Nafamostat mesylate as an anticoagulant (NM-CPB), which reduces postoperative neurological complications.
19 patients with a mean age of 63.6 ± 20.2 years (range 24-91) and an indication of early cardiac surgery with intracranial complication (ICC) underwent surgery with NM-CPB. The preoperative diagnoses included seven cases of infective endocarditis and six of left atrial appendage thrombosis. ICC were noticed in seven cases with hemorrhages (hemorrhagic infarction: n = 4, subarachnoid hemorrhage: n = 3) and 12 without hemorrhage (large infarction: n = 10, small-multiple infarction at the risk for hemorrhagic transformation: n = 2). The mean interval between a diagnosis and cardiac surgery was 1.1 ± 1.5 days in the ICH cases and 1.4 ± 1.4 days otherwise. In-hospital mortality was 5.3%. The mean CPB time was 146.7 ± 66.03 min, the mean dose of NM, heparin were 2.23 ± 1.59 mg/kg/hr and 56.8 ± 20.3 IU/kg, respectively. The mean activated clotting time (ACT) was 426.8 ± 112.4 s. No further intracranial bleeding and no new hemorrhages were observed after surgery.
In early cardiac surgery with ICC, especially with hemorrhage, NM-CPB reduced postoperative neurological complications. We plan to use NM-CPB to expand the indications and to establish an early aggressive treatment.
我们提出了一种新的策略，在心脏手术中使用低剂量肝素和甲磺酸萘莫司他作为抗凝剂的体外循环（NM-CPB），以降低术后神经系统并发症。
19 名平均年龄为 63.6±20.2 岁（范围 24-91 岁）的患者，因颅内并发症（ICC）需要早期心脏手术，接受了 NM-CPB 手术。术前诊断包括 7 例感染性心内膜炎和 6 例左心耳血栓形成。7 例 ICC 患者出现出血（出血性梗死：n=4，蛛网膜下腔出血：n=3），12 例无出血（大面积梗死：n=10，有出血转化风险的小多发性梗死：n=2）。ICH 患者的诊断与心脏手术之间的平均间隔时间为 1.1±1.5 天，其他患者为 1.4±1.4 天。院内死亡率为 5.3%。CPB 时间平均为 146.7±66.03 分钟，NM、肝素的平均剂量分别为 2.23±1.59mg/kg/hr 和 56.8±20.3IU/kg，平均激活凝血时间（ACT）为 426.8±112.4s。术后无进一步颅内出血，也无新的出血。
在伴有出血的 ICC 早期心脏手术中，NM-CPB 可降低术后神经系统并发症。我们计划使用 NM-CPB 来扩大适应证，并建立早期积极治疗。
