Background: Hemostatic alterations are one of the most common postoperative complications in patients who undergo aortic valve replacement surgery with cardiopulmonary bypass (CPB). Excessive bleeding or thrombosis can be associated with a prolonged intensive care unit stay and an increase in morbidity and mortality. In this setting Rotational Thromboelastometry (ROTEM) is a point-of-care equipment that evaluates the viscoelastic properties of whole blood samples and permits an accurate analysis of the whole process of coagulation, which may allow the early detection and treatment of any hemostatic problem.

Aims: To evaluate the global hemostatic status, using ROTEM: clot initiation, formation, consolidation and lysis, of patients undergoing aortic valve replacement before, during and after the cardiopulmonary bypass procedure.

Methods: The citrated blood samples of 33 patients were analysed by ROTEM Delta in three different time points: Before (M1): in the absence of heparin; During (M2): in the presence of heparin, and After(M3): in the presence of protamine; the CPB procedure. The ROTEM analysis included the following tests: INTEM; EXTEM; FIBTEM and HEPTEM, in which Clotting Time (CT); Maximun Clot Firmness (MCF); Alpha Angle () and Maximun Lysis (ML) were measured, along with standard coagulation parameters such as: PT, aPTT, platelet count and fibrinogen.

Results: Complete ROTEM results were available within 15 minutes of test initiation. In INTEM, EXTEM and FIBTEM only M1 and M3 samples were analyzed (Table 1) whereas in HEPTEM all the time points were evaluated (Table 2), resulting, in all the cases, in a statistically significant difference in the different parameters, although all the values were within a normal physiological range. No hyperfibrinolysis was found in any of the patients.

Conclusion(s): According to our experimental conditions, the surgical procedure used appear not to have promoted significant clinical changes in the hemostatic status of patients undergoing aortic valve replacement surgery.

Table.

Table 1. Values of different parameters: Clotting Time -CT-, Maximun Clot Firmness -MCF-, Alpha Angle -- and Maximun Lysis -ML-, in patients undergoing CBP before -M1- and after -M3- the procedure.

Table.

Table 2. Values of different parameters: Clotting Time -CT-, Maximun Clot Firmness -MCF-, Alpha Angle -- and Maximun Lysis -ML- in patients undergoing CBP before -M1-, during -M2- and after -M3- the procedure.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/monitoring-hemostasis-with-rotational-thromboelastometry-rotem-in-patients-undergoing-aortic-valve-replacement-surgery/