Emergency cardiopulmonary bypass in a bilaterally nephrectomized patient with a history of heparin-induced thrombocytopenia: successful reexposure to heparin.

We present a case of emergency coronary artery bypass surgery in a bilaterally nephrectomized patient with a history of heparin-induced thrombocytopenia. The patient was reexposed short term to heparin during cardiopulmonary bypass and did not develop any complications related to heparin-induced thrombocytopenia. Despite intraoperative neutralization of heparin severe bleeding complications occurred, probably resulting from preoperative therapeutic anticoagulation with rhirudin in conjunction with an increased half-life of more than 2 days.

[Anesthesia for minimal invasive coronary surgery without employing extracorporeal circulation]. / Anästhesie zur minimal invasiven Koronarchirurgie ohne Einsatz der extrakorporalen Zirkulation.

In the course of present reevaluation of aortocoronary bypass grafting a minimal invasive surgical procedure avoiding the use of cardiopulmonary bypass has been revised. It is suitable born for palliative treatment of patients with coronary multi-vessel-disease and compromised left ventricular function, and likewise for curative treatment of patients with single-vessel disease of a left coronary artery branch and unimpaired ventricular function. Avoiding possible complications of cardiopulmonary bypass can minimise morbidity and lethality of aortocoronary bypass grafting procedure and can help to lower costs. Anaesthesia for minimal invasive direct coronary artery bypass grafting needs an anaesthesiological concept differing from anaesthesia for conventional coronary artery bypass surgery. This concept, considering the special aims of minimal invasive technique, is discussed and demonstrated by means of case reports.