Main description:

Cardiac surgery has developed dramatically since the first open-he art operations were performed in the mid 1950s. Although the improvement of surgical technique, extracorporeal circulation, and postoperative management has contributed to a marked reduction of morbidity and mortality, the development of cardiac surgery to its present state would not have been possible without blood substitution by homologous donor blood. Only 20 years ago, open-heart operations required an average of 8 units of blood preserves. The excessive need of donor blood in those early days was mainly due to premature surgical technique, insecure control of anticoagulation, severe blood trauma by extracorporeal circulation, and the lack of retransfusion technologies that would have allowed the reuse of shed mediastinal blood. The introduction of new technologies, such as normovolemic hemodilution, in traoperative autotransfusion, postoperative return of shed mediastinal blood, and predonation of autologous blood has greatly reduced donor blood requirements. At present the majority of routine coronary artery surgical procedures can be performed without any blood transfusion. Blood loss, however, may be considerable in patients undergoing complex valve surgery or reoperations, as they often require several units of transfused blood. Blood conservation has now become an area of major interest for the cardiac surgeon. This increased concern is caused by infectious complications of blood transfusion, in particular hepatitis and, more recently, AIDS.

Contents:

I. Pathomechanism of Defective Hemostasis During and After Extracorporeal Circulation.- Fibrinolysis.- Pathomechanisms of Defective Hemostasis During and After Extracorporeal Circulation: Contact Phase Activation.- Pathomechanism of Defective Hemostasis During and After Extracorporeal Circulation: The Role of Platelets.- Blood-Surface Interaction During Cardiopulmonary Bypass.- A Clinical Study on Platelet Preservation in Coronary Artery Bypass Surgery During Cardiopulmonary Bypass without Oxygenator.- The Effect of Aprotinin on Platelet Function and Coagulation In Vitro.- Clinical Impact of Reduced Blood Cell Deformability During Cardiopulmonary Bypass.- Diagnostic Value of Hemostatic Parameters for Prediction of Complications in Patients Undergoing Aorto-Coronary Bypass Grafting.- Summary of Lectures, Posters and Discussion: Pathomechanism.- II. Epidemiology - The Size of the Clinical Problem.- Homologous Blood Use in Cardiac Surgery.- Blood Use in Cardiac Surgery - A Transfusionist's Viewpoint.- Current Risks of Blood Transfusion.- Blood Use in Adult Cardiac Surgery - Extrapolations from the Carola data base.- Evolution of Requirements to Replace Blood and Plasma in Cardiac Surgery.- AIDS and Surgery: On the Need to Reduce the Risks of HIV Infection.- Epidemiology - Screening for Infectious Diseases Transmitted Through Blood and Blood Products.- III: Non-Pharmacological Methods for the Reduction of Blood Use in Cardiac Surgery.- Autologous Blood Predonation.- Resuscitation Fluids for the Treatment of Hemorrhagic Shock in Dogs: The Effects on Myocardial Blood Flow.- Reduction of Blood Use in Cardiac Surgery by Topical Hemostasis Using Fibrin Sealant.- Retransfusion of Postoperative Drainage Blood.- Bacteriological Methods to Monitor the Quality of Intraoperative Autotransfusion.- Blood Salvage in Cardiac Surgery: Comparative Analysis of Three Procedures.- Inflammatory Response Due to Cell-Saver in Cardiac Surgery.- Open-Heart Surgery in Jehovahs Witnesses.- Autologous Blood Transfusion in Cardiac Surgery - 15-Year Experience.- Preoperative Autologous Blood Donation to Minimize Homologous Blood Transfusions.- Use of Predonated Autologous Blood in Cardiac Surgery.- Blood Use Reduction by Predonation - How Effective is It?.- Autologous Blood Transfusion in Cardiac Surgery.- Intraoperative Blood Conservation Using Cell-Saver.- Intraoperative Autotransfusion.- Cardiac Surgery in Jehovah's Witnesses: An Experience of 62 Cases.- Reduction of Homologous Blood Requirement During Myocardial Revascularization - Comparison of Four Different Techniques.- IV. Pharmacological Methods for the Reduction of Blood Use in Cardiac Surgery.- Platelet Dysfunction after Coronary Artery Bypass Surgery.- Clinical Effectiveness of Aprotinin in Heart Surgery.- Safety and Risk/Benefit Assessment of Aprotinin in Primary CABG.- Investigation on the Mechanisms of Action of Aprotinin in Cardiac Surgery.- High-dose Aprotinin Reduces Bleeding in Patients Taking Aspirin at the Time of Aorto-Coronary Bypass Surgery.- Preserved Hemostasis During the Combined Use of Aprotinin and Aspirin in CABG Operations.- ACT and Aprotinin.- Aprotinin: Effect on "Re-Do" Surgery.- The Edinburgh Experience - Low-dose Trasylol.- Reduction of Blood Use by Aprotinin After Heart-Transplantation.- Blood Damage and Activation in Cardiopulmonary Bypass.- V. Panel Discussion.- Changing Concepts of Blood Use in Cardiac Surgery.