The use of an autologous fibrin sealant during a complex cardiac surgical procedure

Due to substantial perioperative injuries and changes in coagulation, cardiac surgery procedures using extracorporeal circulation often necessitate the transfusion of blood products [1]. This pertains especially to patients in whom the procedures involve prolonged periods of extracorporeal circulation and aortic clamping [2]. Although allogenic blood products have been used in the treatment of hemorrhages or significant anemia for many years, it has been proven that their transfusion is associated with the risk of numerous complications [3, 4]. The methods for limiting or eliminating perioperative bleeding include the use of absorbable sponges soaked with blood products (e.g., thrombin) and the use of tissue glue. One special type of such glue is fibrin sealant derived from the patient’s autologous blood acquired intraoperatively [5]. We present a report of one of the first uses of the fibrin sealant Vivostat in Poland; it was used in a patient undergoing a complex procedure involving the implantation of an aortic valve prosthesis and an ascending aortic prosthesis.
The 57-year-old male patient was admitted to our center in order to undergo surgical treatment of aortic valve stenosis and ascending aortic dilatation. When interviewed, the patient reported significant impairment of exercise tolerance (classified as NYHA III based on the reported symptoms), which had been increasing for approximately 6 months, and single episodes of syncope. His medical history included coronary artery disease, treated with the implantation of a drug-eluting stent into the anterior descending branch of the left coronary artery 5 years prior, and the associated monotherapy with acetylsalicylic acid. Control coronary angiography revealed no signs of restenosis or new significant stenoses in the coronary arteries. Echocardiographic examination showed severe stenosis of the bicuspid aortic valve (mean gradient: 42 mm Hg; indexed effective orifice area: 0.5 cm²/m²; 2nd degree regurgitation). Other findings included: left ventricular (LV) diameter – 50 mm, end-diastolic LV volume – 214 ml, interventricular septal (IVS) thickness – 17 mm, posterior LV wall – 13 mm, IVS dyskinesia, hypokinesia of the lateral wall, left ventricular ejection fraction reduced to 50% and supracoronary dilatation of the ascending aorta to approx. 50 mm. Electrocardiography showed normal sinus rhythm.
During a detailed conversation, the patient was presented with the...


View full text...