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Aggressive early surgical strategy in patients with intracranial hemorrhage: a new cardiopulmonary bypass option

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Abstract

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.

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Acknowledgements

The authors would like to thank Prof. Emeritus Yutaka Okita and the department of cardiovascular surgery Kobe University for their kind guidance and continuous support.

Funding

The authors declare no grants, and sources of funding related to the manuscript.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Okinawa Nanbu Prefectural Medical Center and Childrenʼs Medical Center, 118-1, Aza-arakawa, Haebaru-cho, Shimajiri-gun, Okinawa, 901-1193, Japan

    Takahiro Yamazato, Noriko Oyama, Takayuki Fujii, Noriyuki Abe & Hiroshi Munakata

  2. Department of Clinical Engineering, Okinawa Nanbu Prefectural Medical Center and Childrenʼs Medical Center, Okinawa, Japan

    Yuta Ikemiya &  YutakaTamashiro

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  1. Takahiro Yamazato
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  2. Noriko Oyama
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  3. Takayuki Fujii
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  4. Noriyuki Abe
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  5. Yuta Ikemiya
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Correspondence to Takahiro Yamazato.

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Institutional review board approval

All procedures used in this research were approved by the Ethical Committee of Okinawa Nanbu Prefectural Medical Center and Childrenʼs Medical Center, (No 22, Jun 29, 2017).

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Written informed consent was obtained from the patient for publication of this article and accompanying images.

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Yamazato, T., Oyama, N., Fujii, T. et al. Aggressive early surgical strategy in patients with intracranial hemorrhage: a new cardiopulmonary bypass option. Gen Thorac Cardiovasc Surg 70, 602–610 (2022). https://doi.org/10.1007/s11748-021-01743-w

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  • DOI: https://doi.org/10.1007/s11748-021-01743-w

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