Objectives

The symposium will present the coagulation and fibrinolytic changes associated with cardiopulmonary bypass, and the underlying physiologic mechanisms. Strategies to minimize these changes, and reduce the need for blood transfusions and blood products will be discussed. These include: On site monitoring of microvascular bleeding intraoperatively, the use of autologous transfusion, transfusion of shed blood preoperatively, and the use of Erythropoietin. Pharmacologic control of bleeding using Epsilon-Aminocaproic Acid, DD/AVP, Tranexamic Acid, and Aprotinin will be presented. Discussion will focus on areas of controversies and the sequential management of the bleeding cardiac surgery patient.

Registration

Enrollment in this course will be by preregistration until March 26, 1993. Registration forms will be processed in the order in which they are received and must be accompanied by payment in full. After March 26, 1993, participants may register on site. The registration fee is $20.00.

Accreditation

The American Association for Thoracic Surgery is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing education for physicians. The American Association for Thoracic Surgery designates this continuing medical education activity for 3.5 credit hours in Category 1 of the Physicians Recognition Award of the American Medical Association.

Program - Grand Ballroom F

SESSION I BALANCING BLOOD TRANSFUSION AND BLOOD CONSERVATION

Moderator: Safuh Attar, M.D., Baltimore, Maryland

1:30 p. m. Introduction:

THE SCOPE OF THE PROBLEM: BLOOD TRANSFUSIONS, SAFETY, RISKS, BENEFITS AND COSTS

Safuh Attar, M.D., Baltimore, Maryland

1:40 p.m. CURRENT TRANSFUSION PRACTICE IN CARDIAC SURGERY

Lawrence Tim Goodnough, M.D., St. Louis, Missouri

2:00 p.m. SHOULD PREOPERATIVE AUTOLOGOUS BLOOD DONATIONS BE ROUTINE BEFORE CARDIAC SURGERY?

Robert L. Thurer, M.D., Boston, Massachusetts

2:20 p.m. THE ACQUIRED HEMOSTASIS DEFECTS RELATED TO EXTRACORPOREAL CIRCULATION AND THEIR EFFECT ON BLOOD LOSS

L. Henry Edmunds, Jr., M.D., Philadelphia, Pennsylvania

2:40 p.m. ON-SITE COAGULATION MONITORING: THE IMPACT ON INTRAOPERATIVE HEMOSTASIS AND TRANSFUSION NEEDS

George J. Despoils, M.D., Kirkwood, Missouri

3:00 p.m. COFFEE BREAK

SESSION II PHARMACOLOGIC APPROACHES TO REDUCE BLOOD TRANSFUSION REQUIREMENTS

Moderator: Lawrence Tim Goodnough, M.D., St. Louis, Missouri

3:30 p.m. RECOMBINANT HUMAN ERYTHROPOIETIN THERAPY

Michael D'Ambra, M.D., Boston, Massachusetts

3:50 p.m. APROTININ THERAPY IN AORTO-CORONARY BYPASS

Benjamin P. Bidstrup, FRACS, FRCSEd

London, England

4:10 p.m. APROTININ THERAPY: BLOOD LOSS, BLOOD TRANSFUSION, GRAFT PATENCY

Delos M. Cosgrove, M.D., Cleveland, Ohio

4:30 p.m. DDAVP AND TRANEXAMIC ACID THERAPY

John W. Mammon, Jr., M.D.

Winston-Salem, North Carolina

4:50 p.m. PANEL DISCUSSION: IS BLOODLESS SURGERY A REALISTIC GOAL?

5:30 p.m. MEETING ADJOURNS