ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Parwis Massoudy
Matthias Thielmann
Ivan Aleksic
Wulf Dietrich
Heinz Jakob
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Massoudy, P.
Right arrow Articles by Jakob, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Massoudy, P.
Right arrow Articles by Jakob, H.
Related Collections
Right arrow Cardiac - other
Right arrow Extracorporeal circulation

Ann Thorac Surg 2006;82:2187-2191
© 2006 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Thrombophilia in Cardiac Surgery—Patients With Protein S Deficiency

Parwis Massoudy, MDa,*, Matthias Thielmann, MDa, Hannes Müller-Beißenhirtz, MDb, Ivan Aleksic, MDa, Günter Marggraf, MDa, Wulf Dietrich, MDc, Heinz Jakob, MDa

a Department of Thoracic and Cardiovascular Surgery, West German Heart Center, Essen
b Department of Hematology and Oncology, University Hospital, Essen
c Department of Anesthesiology, German Heart Center, Munich, Germany

Accepted for publication June 27, 2006.

* Address correspondence to Dr Massoudy, Klinik für Thorax- und Kardiovaskuläre Chirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147 Essen, Germany (Email: parwis.massoudy{at}uni-essen.de).

BACKGROUND: Thrombophilic diathesis may cause severe problems in cardiac surgical patients. Among these, protein S deficiency is a coagulation disorder associated with recurrent thromboembolic events. We analyzed our experience with 7 patients with protein S deficiency who underwent cardiac surgery.

METHODS: We retrospectively reviewed the clinical data, operative and postoperative courses, and the long-term results of 7 patients who were diagnosed to have protein S deficiency. Six of them were operated on using cardiopulmonary bypass, one was operated on with an off-pump procedure.

RESULTS: Procedures performed were emergent pulmonary embolectomy (patient 1), aortic valve replacement and coronary artery bypass grafting (CABG, patient 2), re-CABG (patients 3 and 7), and CABG (patients 4, 5, and 6). In patients 1, 2, 3, and 7, the diagnosis was made perioperatively. Patients 4, 5, and 6 were treated with a modified regimen of warfarin or protamine. All of the latter 3 patients had an uneventful perioperative course without thromboembolic complication. At follow-up, all but 1 of the 7 patients were on continuous warfarin, and were well and without any further thromboembolic events.

CONCLUSIONS: In patients with a past medical history of thromboembolic events or with a perioperative thromboembolic complication, elaborate laboratory investigation should lead to a definite diagnosis. For instance, patients with protein S deficiency undergoing cardiac surgery belong to a high-risk subgroup. Although rare, this and other coagulation disorders can be a critical issue in cardiac surgery. In such patients, we suggest perioperative warfarin therapy with a target international normalized ratio of 2.0 and incomplete protamine antagonism to minimize the risk of a perioperative thromboembolic event.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The Society of Thoracic Surgeons.