Management of acute cardiac tamponade by direct autologous blood transfusion in interventional electrophysiology.

AIMS: Acute cardiac tamponade (ACT) is the most common life-threatening complication of interventional electrophysiology. Urgent drainage by percutaneous pericardiocentesis and anticoagulation reversal are required. Immediate direct transfusion of the blood volume aspirated from the pericardial space to the patient has been rarely described. This study was designed to assess the efficacy and safety of immediate direct autologous blood transfusion (AutoBT). METHODS: A retrospective case series of direct AutoBT performed for ACT was collected. Urgent drainage by percutaneous pericardiocentesis and immediate direct AutoBT were performed to achieve hemodynamic stabilization without a cell-saver system. RESULTS: Twenty-two electrophysiology centers were contacted to participate in the case series. Fourteen centers reported not to use direct AutoBT. Three centers reported using direct AutoBT with the cell-saver system. Fourteen cases of immediate direct AutoBT without cell-saver system were included from the five remaining centers. Electrophysiological procedures were performed for ventricular tachycardia (n = 5), atrial fibrillation (n = 5), atrial tachycardia (n = 2), left accessory pathway (n = 1), and premature ventricular contraction (n = 1) with transseptal (n = 9), retroaortic (n = 4), and/or epicardial access (n = 4). Pericardial drainage was performed by percutaneous pericardiocentesis for 13 patients and via the transseptal sheath for one patient. Surgical hemostasis was required for seven patients. The mean volume of autologous blood directly transfused was 1207 ± 963 mL. Direct AutoBT permitted to resume the procedure in four patients. No major complication related to the use of AutoBT occurred. CONCLUSION: Direct AutoBT without a cell-saver system is a feasible, safe, and useful technique for salvage therapy in ACT in interventional electrophysiology.

Management of patients with asymptomatic moderate aortic stenosis undergoing coronary artery bypass grafting.

BACKGROUND AND AIMS OF THE STUDY: Manual decalcification of the aortic valve was performed systematically in a prospective series of patients with asymptomatic moderate aortic stenosis (AS) undergoing coronary artery bypass grafting (CABG). This study addressed two main issues: (i) whether aortic valve decalcification is a good option to relieve moderate AS; and (ii) whether the natural progression of AS may be delayed by manual valve debridement when surgery is indicated for coronary disease. METHODS: Between October 1997 and March 2001, 14 adult patients with moderate AS underwent concomitant surgical repair of the aortic valve during CABG. Manual valve debridement with restoration of cusp mobility was attempted. Calcified deposits were removed by careful dissection. All patients underwent myocardial revascularization; a mean of 2.38 grafts was performed per patient. RESULTS: Immediately after surgery, mean aortic valve area index (AVAI) was improved, from 0.56+/-0.12 to 1.43+/-0.25 cm2/m2. Patients with the slowest recalcification rates were those with a postoperative/preoperative AVAI ratio of 1.6 to 2.4, those in whom the degree of postoperative aortic insufficiency was very similar to the degree of preoperative regurgitation, and those in whom the preoperative AVAI was >0.55 cm2/m2. CONCLUSION: Manual aortic valve debridement for moderate AS is a good option when surgery must be performed for coronary disease; the best results were obtained in patients with senile stenosis of a tricuspid aortic valve with an AVAI of 0.55-0.9 cm2/m2.