Objective

We present a novel strategy in cardiac surgery with a cardiopulmonary bypass with low-dose heparin and Nafamostat mesylate as an anticoagulant (NM-CPB), which reduces postoperative neurological complications.

Method and results

19 patients with a mean age of 63.6 ± 20.2 years (range 24–91) and an indication of early cardiac surgery with intracranial complication (ICC) underwent surgery with NM-CPB. The preoperative diagnoses included seven cases of infective endocarditis and six of left atrial appendage thrombosis. ICC were noticed in seven cases with hemorrhages (hemorrhagic infarction: n = 4, subarachnoid hemorrhage: n = 3) and 12 without hemorrhage (large infarction: n = 10, small-multiple infarction at the risk for hemorrhagic transformation: n = 2). The mean interval between a diagnosis and cardiac surgery was 1.1 ± 1.5 days in the ICH cases and 1.4 ± 1.4 days otherwise.

In-hospital mortality was 5.3%. The mean CPB time was 146.7 ± 66.03 min, the mean dose of NM, heparin were 2.23 ± 1.59 mg/kg/hr and 56.8 ± 20.3 IU/kg, respectively. The mean activated clotting time (ACT) was 426.8 ± 112.4 s. No further intracranial bleeding and no new hemorrhages were observed after surgery.

Conclusions

In early cardiac surgery with ICC, especially with hemorrhage, NM-CPB reduced postoperative neurological complications. We plan to use NM-CPB to expand the indications and to establish an early aggressive treatment.

中文翻译：

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颅内出血患者的积极早期手术策略：一种新的体外循环选择

客观的

我们提出了一种新的心脏手术策略，使用低剂量肝素和甲磺酸萘莫司他作为抗凝剂 (NM-CPB) 进行体外循环，从而减少术后神经系统并发症。

方法和结果

19 名平均年龄为 63.6 ± 20.2 岁（范围 24-91）且有颅内并发症（ICC）早期心脏手术指征的患者接受了 NM-CPB 手术。术前诊断包括 7 例感染性心内膜炎和 6 例左心耳血栓形成。在 7 例出血（出血性梗塞：n  = 4，蛛网膜下腔出血：n  = 3）和 12 例无出血（大梗塞：n  = 10，有出血转化风险的小多发梗塞：n  = 2）中发现 ICC . 在 ICH 病例中，诊断和心脏手术之间的平均间隔为 1.1 ± 1.5 天，否则为 1.4 ± 1.4 天。

住院死亡率为5.3%。平均 CPB 时间为 146.7 ± 66.03 min，NM、肝素的平均剂量分别为 2.23 ± 1.59 mg/kg/hr 和 56.8 ± 20.3 IU/kg。平均活化凝血时间 (ACT) 为 426.8 ± 112.4 s。术后未观察到进一步颅内出血和新的出血。

结论

在 ICC 的早期心脏手术中，尤其是出血时，NM-CPB 减少了术后神经系统并发症。我们计划使用 NM-CPB 扩大适应症并建立早期积极治疗。