Fibrinogen Level and Its Influence on Cardiopulmonary Bypass in Surgery for Aortic Dissection

(Department of Cardiovascular Surgery, National Hospital Tokyo Disaster Medical Center, Tokyo, Japan and The Second Department of Surgery, Nihon University School of Medicine*, Tokyo, Japan)

Saeki Tsukamoto Shoji Shindo Masahiro Obana
Kenji Akiyama* Motomi Shiono* Nanao Negishi*
For the purpose of reducing blood loss and blood transfusion, 100 cases of acute aortic dissection treated at this department were studied, focusing on surgery for aortic dissection and coagulation factors, fibrinogen in particular. In cases of aortic dissection, fibrinogen decreased at the acute stage, and showed concentrations significantly lower in Stanford Type A than in Stanford Type B, in extensive dissection (DeBakey Type I or Type III retrograde dissection) than in limited dissection (DeBakey Type II), and in open false lumen type than in closed false lumen type. In the assessment of 34 cases of acute Stanford Type A aortic dissection operated on within 24h of onset, it was found that a marked prolongation of activated clotting time (ACT1,000s) during cardiopulmonary bypass causes an increase in blood transfusion. When ACT was maintained for 400s or longer, to inhibit the marked prolongation of ACT, by changing at any time the dose of heparin during cardiopulmonary bypass by 50 -250units/kg on the basis of the preoperative fibrinogen level, instead of fixing it at 300units/kg, ACT decreased significantly, and was controlled at appropriate levels despite the low concentration of fibrinogen. As fibrinogen can be measured in the hospital, and the result obtained in a short time, it is considered to play an important role in controlling ACT to determine the dose of heparin based on its concentration.
@Jpn. J. Cardiovasc. Surg. 32F121 -125 (2003)