Spampinato N

Can ε-aminocaproic acid balance the off-pump bleeding advantage?

Abstract Background : Aprotinin improved the control of bleeding in patients undergoing surgery with cardiopulmunary bypass, but its use was halted because of the risk of bovine spongiform encephalopathy. We then started to use e -aminocaproic acid and the results in the control of bleeding were satisfactory. To assess its effectiveness in the control of postoperative bleeding precisely, we compared the results for patients operated on for myocardial revascularization on-pump and treated with e -aminocaproic acid with those for patients who decidedly bleed less: off-pump patients. Methods : Two groups of patients who had had either on- or off-pump double aortocoronary bypass surgery were retrospectively reviewed for postoperative bleeding. These two almost homogeneous group had two grafts only: left anterior descending and circumflex arteries operated on with cardiopulmonary bypass and treated with the e -aminocaproic acid, and left anterior descending and right coronary arteries operated on off-pump. Results : Postoperative bleeding through chest drainage at 4 h was 265±91.7 mL in the off-pump group and 328.4±131.4 mL in the on-pump group ( p =0.004). But at 24 h it was 671.6±311.5 mL in the off-pump group and 827.8±514.4 mL in the on-pump group ( p =0.07). Conclusions : e -Aminocaproic acid is effective in controlling postoperative bleeding in patients operated on for myocardial revascularization with the aid of cardiopulmonary bypass.

Percutaneous Transluminal Coronary Angioplasty in Progressive Myocardial Ischemia: Medium-term Results

Percutaneous transluminal coronary angioplasty (PTCA) has undergone a major evolution since 1977, when Gruentzig and coworkers [3] made their first balloon dilatation. The success rate with PTCA has improved, ranging from 60% to about 90%, as the experience of operators (learning curve) and availability of materials have increased. Most recently, some authors [2, 9] have also employed this procedure in cases of multiple-vessel disease, stenoses of saphenous vein grafts, and acute ischemic episodes. Initially, our experience — at the Department of Cardiovascular Surgery, 2nd Medical School University of Naples, Italy — was restricted to only single (rarely double) and proximal coronary artery narrowing and especially to patients with progressive myocardial ischemia.