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202. Topical thrombin preparations and their use in cardiac surgery

Author

Dunn,Brianne L, Uber,Walter E, Ikonomidis,John, Dunn,Brianne L, Uber,Walter E, and Ikonomidis,John

Abstract

Brianne L Dunn1, Walter E Uber1, John S Ikonomidis21Department of Pharmacy Services and 2Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USAAbstract: Coagulopathic bleeding may lead to increased morbidity and mortality after cardiac surgery. Topical bovine thrombin has been used to promote hemostasis after surgical procedures for over 60 years and is used frequently as a topical hemostatic agent in cardiac surgery. Recently, use of bovine thrombin has been reported to be associated with increased risk for anaphylaxis, thrombosis, and immune-mediated coagulopathy thought secondary to the production of antifactor V and antithrombin antibodies. In patients who develop bovine thrombin-induced immune-mediated coagulopathy, clinical manifestations may range from asymptomatic alterations in coagulation tests to severe hemorrhage and death. Patients undergoing cardiac surgical procedures may be at increased risk for development of antibodies to bovine thrombin products and associated complications. This adverse immunologic profile has led to the development of alternative preparations including a human and a recombinant thrombin which have been shown to be equally efficacious to bovine thrombin and have reduced antigenicity. However, the potential benefit associated with reduced antigenicity is not truly known secondary to the lack of long-term experience with these products. Given the potentially higher margin of safety and less stringent storage concerns compared to human thrombin, recombinant thrombin may be the most reasonable approach in cardiac surgery.Keywords: bovine thrombin, human thrombin, recombinant thrombin, immune-mediated coagulopathy, topical hemostatic agents, thrombin&nbsp

Published
2009

203. Pulmonary Artery Endothelial Cell Phenotypic Alterations in a Large Animal Model of Pulmonary Arteriovenous Malformations After the Glenn Shunt

Author

Kavarana, Minoo N., primary, Mukherjee, Rupak, additional, Eckhouse, Shaina R., additional, Rawls, William F., additional, Logdon, Christina, additional, Stroud, Robert E., additional, Patel, Risha K., additional, Nadeau, Elizabeth K., additional, Spinale, Francis G., additional, Graham, Eric M., additional, Forbus, Geoffrey A., additional, Bradley, Scott M., additional, Ikonomidis, John S., additional, and Jones, Jeffrey A., additional

Published
2013
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204. Reproducible Porcine Model of Thoracic Aortic Aneurysm

Author

Eckhouse, Shaina R., primary, Logdon, Christina B., additional, Oelsen, J. Marshall, additional, Patel, Risha K., additional, Rice, Allison D., additional, Stroud, Robert E., additional, Wince, W. Benjamin, additional, Mukherjee, Rupak, additional, Spinale, Francis G., additional, Ikonomidis, John S., additional, and Jones, Jeffrey A., additional

Published
2013
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205. Patient Safety in the Cardiac Operating Room: Human Factors and Teamwork

Author

Wahr, Joyce A., primary, Prager, Richard L., additional, Abernathy, J.H., additional, Martinez, Elizabeth A., additional, Salas, Eduardo, additional, Seifert, Patricia C., additional, Groom, Robert C., additional, Spiess, Bruce D., additional, Searles, Bruce E., additional, Sundt, Thoralf M., additional, Sanchez, Juan A., additional, Shappell, Scott A., additional, Culig, Michael H., additional, Lazzara, Elizabeth H., additional, Fitzgerald, David C., additional, Thourani, Vinod H., additional, Eghtesady, Pirooz, additional, Ikonomidis, John S., additional, England, Michael R., additional, Sellke, Frank W., additional, and Nussmeier, Nancy A., additional

Published
2013
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208. Forecasting the Impact of Heart Failure in the United States

Author

Heidenreich, Paul A., primary, Albert, Nancy M., additional, Allen, Larry A., additional, Bluemke, David A., additional, Butler, Javed, additional, Fonarow, Gregg C., additional, Ikonomidis, John S., additional, Khavjou, Olga, additional, Konstam, Marvin A., additional, Maddox, Thomas M., additional, Nichol, Graham, additional, Pham, Michael, additional, Piña, Ileana L., additional, and Trogdon, Justin G., additional

Published
2013
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209. Choosing Wisely: Cardiothoracic Surgeons Partnering With Patients to Make Good Health Care Decisions

Author

Wood, Douglas E., primary, Mitchell, John D., additional, Schmitz, DeLaine S., additional, Grondin, Sean C., additional, Ikonomidis, John S., additional, Bakaeen, Faisal G., additional, Merritt, Robert E., additional, Meyer, Dan M., additional, Moffatt-Bruce, Susan D., additional, Reece, T. Brett, additional, and Smith, Michael A., additional

Published
2013
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211. Abstract 14357: A Reproducible Porcine Model of Thoracic Aortic Aneurysm

Author

Eckhouse, Shaina R, primary, Patel, Risha K., additional, Rice, Allison D., additional, Logdon, Christina B., additional, Oelsen, J. Marshall, additional, Stroud, Robert E., additional, Wince, William B., additional, Mukherjee, Rupak, additional, Spinale, Francis G., additional, Ikonomidis, John S., additional, and Jones, Jeffrey A., additional

Published
2012
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216. Selective MicroRNA Suppression in Human Thoracic Aneurysms

Author

Jones, Jeffrey A., primary, Stroud, Robert E., additional, O'Quinn, Elizabeth C., additional, Black, Laurel E., additional, Barth, Jeremy L., additional, Elefteriades, John A., additional, Bavaria, Joseph E., additional, Gorman, Joseph H., additional, Gorman, Robert C., additional, Spinale, Francis G., additional, and Ikonomidis, John S., additional

Published
2011
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234. Reply

Author

Ikonomidis, John S., primary, Uber, Walter, additional, and Stroud, Martha, additional

Published
2008
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243. Membrane-type-1 matrix metalloproteinase transcription and translation in myocardial fibroblasts from patients with normal left ventricular function and from patients with cardiomyopathy

Author

Spruill, Laura S., primary, Lowry, Abigail S., additional, Stroud, Robert E., additional, Squires, Christina E., additional, Mains, Ira M., additional, Flack, English C., additional, Beck, Christy, additional, Ikonomidis, John S., additional, Crumbley, A. Jackson, additional, McDermott, Paul J., additional, and Spinale, Francis G., additional

Published
2007
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248. Comparison of David V valve-sparing root replacement and bioprosthetic valve conduit for aortic root aneurysm.

Author

DeNino, Walter F., Toole, John Matthew, Rowley, Christopher, Stroud, Martha R., and Ikonomidis, John S.

Abstract

Objective: Valve sparing root replacement (VSRR) is an attractive option for the management of aortic root aneurysms with a normal native aortic valve. Therefore, we reviewed our experience with a modification of the David V VSRR and compared it with stented pericardial bioprosthetic valve conduit (BVC) root replacement in an age-matched cohort of older patients. Methods: A total of 48 VSRRs were performed at our institution, excluding those on bicuspid aortic valves. We compared these cases with 15 aortic root replacements performed using a BVC during the same period. Subgroup analysis was performed comparing 16 VSRR cases and 15 age-matched BVC cases. Results: The greatest disparity between the VSRR and BVC groups was age (53 vs 69 years, respectively; P < .0005). The matched patients were similar in terms of baseline demographics and differed only in concomitant coronary artery bypass grafting (2 VSRR vs 7 BVC patients; P = .036). None of the VSRR and 3 of the BVC procedures were performed for associated dissection (P = .101). Postoperative aortic insufficiency grade was significantly different between the 2 groups (P = .004). The cardiopulmonary bypass, crossclamp, and circulatory arrest times were not different between the VSRR and BVC groups (174 vs 187 minutes, P = .205; 128 vs 133 minutes, P = .376; and 10 vs 13 minutes, respectively; P = .175). No differences were found between the 2 groups with respect to postoperative complications. One postoperative death occurred in the BVC group and none in the VSRR group. The postoperative length of stay and aortic valve gradients were less in the VSRR group (6 vs 8 days, P = .038; 6 vs 11.4 mm Hg, P = .001). The intensive care unit length of stay was significantly less in the VSRR group (54 vs 110 hours, P = .001). Conclusions: VSRR is an effective alternative to the BVC for aortic root aneurysm. [ABSTRACT FROM AUTHOR]

Published
2014
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