Microporous polysaccharide hemosphere absorbable hemostat use in cardiothoracic surgical procedures
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RESEARCH ARTICLE
Open Access
Microporous polysaccharide hemosphere absorbable hemostat use in cardiothoracic surgical procedures Brian A Bruckner*, Lance N Blau, Limael Rodriguez, Erik E Suarez, Uy Q Ngo, Michael J Reardon and Matthias Loebe
Abstract Background: Topical hemostatic agents are used to reduce bleeding and transfusion need during cardiothoracic surgery. We report our experience with Arista® AH Absorbable Hemostatic Particles (Arista® AH), a novel plant-based microporous polysaccharide hemostatic powder. Methods: Data were retrospectively collected for patients (n = 240) that received cardiothoracic surgery at our institution from January 2009 to January 2013 with (n = 103) or without (n = 137) the use of Arista® AH. Endpoints included protamine to skin closure time (hemostasis time), cardiopulmonary bypass time, quantity of Arista® AH applied, intraoperative blood product usage, intraoperative blood loss, chest tube output 48 hours postoperatively, blood products required 48 hours postoperatively, length of stay in the intensive care unit, 30-day morbidity, and 30-day mortality. Results: 240 patients (176 M: 64 F) underwent 240 cardiothoracic procedures including heart transplantation (n = 53), cardiac assist devices (n = 113), coronary artery bypass grafts (n = 20), valve procedures (n = 19), lung transplantation (n = 17), aortic dissection (n = 8), and other (n = 10). Application of Arista® AH led to significant reduction in hemostasis time versus the untreated control group (Arista® AH: 93.4 ± 41 min. vs. Control: 107.6 ± 56 min., p = 0.02). Postoperative chest tube output in the first 48 hours was also significantly reduced (Arista® AH: 1594 ± 949 mL vs. Control: 2112 ± 1437 mL, p < 0.001), as well as transfusion of packed red blood cells (Arista® AH: 2.4 ± 2.5 units vs. Control: 4.0 ± 5.1 units, p < 0.001). There was no significant difference in 30-day mortality or postoperative complications. Conclusion: Use of Arista® AH in complex cardiothoracic surgery resulted in a significant reduction in hemostasis time, postoperative chest tube output, and need for postoperative blood transfusion. Keywords: Bleeding control, Biomaterials, Coagulants
Background Postoperative bleeding complications are associated with poorer outcomes in cardiac surgery and contribute to excessive overall healthcare costs. The need for intraoperative and postoperative blood products are also associated with potential risks including adverse reactions, transfusion related injury, or infectious transmissions that are significant factors for morbidity or mortality [1]. In their study examining open heart procedures requiring re-exploration for bleeding, Hall et al. described that * Correspondence: [email protected] Houston Methodist Hospital, Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
66% of cases were from surgical bleeding versus 34% attributed to coagulopathy where no surgical bleeding site was found [2]. Bleeding arises as a result of several aspects inherent to these cardiac procedures, i
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