Bell, Angela "Evaluation of platelet function assays: analysis of advantages, disadvantages and limitations in predicting bleeding" |
| May 2009, 152pp, 67 references, tables, figures, nomenclature |
| Available for checkout |
Abstract: Clinicians, perfusionists, and all those involved in cardiopulmonary bypass and hemostatic management rely on platelet function assays to make clinical decisions. Such decisions might include the administration of pharmaceuticals or the use of various blood products -- each of which has its own costs and risks associated with it. Therefore, it is critical that the data provided by the platelet function assays are accurate and used within the correct context.
A brief review of the literature indicates that clinical decisions seldom take into account the shortcomings associated with the various platelet function tests in use, particularly the associated lack of sensitivity and specificity. Clinicians use the results from these tests to guide hemostatic management despite a lack of evidence supporting their use in this manner. This project was designed to investigate several platelet function assays currently on the market including their advantages, disadvantages, and most appropriate uses.
It found that everything from the anticoagulant used to the method of collection may have a profound effect on the platelet function tests. This project summarizes the important considerations of each of the platelet function tests and provides recommendations for which assays to use in various situations. This project provides students, clinicians, and perfusionists with a concise guide to many platelet function assays currently available for use in hemostatic management and when they can be used effectively. |
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Kaczanowski, Tracy "Perioperative and early postoperative patient outcomes of robotic versus sternotomy mitral valve surgery : a retrospective study" |
| May 2010, 120pp |
| Available for checkout |
Abstract: Mitral valve (MV) surgery is traditionally approached via median sternotomy. Robotic-assisted MV surgery is performed through smaller incisions and avoids the median sternotomy. By minimizing incisional trauma, robotic surgery is thought to yield superior patient outcomes to open sternotomy procedures. However, studies directly comparing patient outcomes of robotic and sternotomy MV surgeries are lacking in the literature. The purpose of this study is to provide a direct statistical comparison of short-term patient outcomes of robotic versus sternotomy MV surgeries at Aurora St. Luke's Medical Center in Milwaukee, Wisconsin.
Data were respectively obtained from the Society of Thoracic Surgeon's database. All patients who underwent robotic MV surgery were included in the study (n=55). A cohort of patients who underwent MV surgery via sternotomy were retrospectively selected based on equivalence of demographic characteristics, comorbidities, and medical history (n=230). Patients who had robotic MV surgery experienced longer CPB and cross-clamp times; fewer transfusions of packed red blood cells, platelets, fresh frozen plazma, and cryoprecipitate; shorter length of stay; and possible a shorter ICU length of stay. There were no significant differences in mechanical ventilation time, 30-day mortality, renal complications, heart block, reoperation for bleeding, new-onset atrial fibrillation, stroke, or 30-day readmission.
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Riddle, Emily V. "A Retrospective Study of Patient Outcomes Following Transfusions with Either Fresh or Aged Packed Red Blood Cells" |
| Nov. 2007, 108pp, 52 references |
- Appendix A: Chi-Square Test: Fischer's Exact Test of Postoperative Complications
- Appendix B: Analysis of Variance Testing of Co-Morbidities
- Appendix C: Variables of Stepwise Binary Logistic Regression
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| Abstract: The argument of when to transfuse a patient has been, and still is, a controversial issue in operating rooms around the country. Over the past few decades much research has focused on problems that are associated with transfusions. These problems included the chance of disease transmission and transfusion reactions which were associated with human-error during blood typing. More recently, it has been noted that postoperative complication risk rises with the use of packed red blood cells (pRBCs). Some of this research has focused on the complications associated with the age of transfused pRBCs. Several studies have noted the changes that occur within the storage lesion can increase mortality rates, length of hospital stay, renal and pulmonary insufficiency and infection rates. This thesis focused on performing a retrospective study to investigate how the age of pRBCs correlated with postoperative complications. The study used data from coronary artery bypass grafting (CABG) patients at Saint Luke's Medical Center in Milwaukee, Wisconsin. The age of pRBCs administered were compared to various postoperative complications. This study also involved determining which risk factors were the best predictors of postoperative pulmonary insufficiency, postoperative renal failure, mortality and cardiac arrest. Results indicated that the addition of pRBCs >= 14 days old increased a patient's risk of developing pulmonary insufficiency by 2.3 times. It was also found that the addition of pRBCs>= 14 days old also increased a patient's risk of developing renal failure, mortality, and cardiac arrest by 5.6 times. Outcomes from this research show that there is increased risk associated with the administration of older pRBCs; however, because the population size was small, stronger associations between the age of pRBCs transfused and postoperative complications could not be made. |
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Touroo, Jeremy S. "A Simulink Model of the Pediatric Cardiovascular System Following Stage I Surgical Palliation of Hypoplastic Left Heart Syndromes" |
| May 2008, 115pp, 72 references |
- Appendix A: Simulink Model Details: Top-Level System
- Appendix B: Simulink Model Details: Heart and Vascular Subsystems
- Appendix C: Simulink Model Details: Oxygen Calculations
- Appendix D: Simulink Blocks
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| Available for checkout |
| Abstract: Hypoplastic left heart syndrome is a rare congenital heart abnormality that involves hypoplasia of left-sided cardiac structures such as the aortic valve, left ventricle, mitral valve, and ascending aorta, and the condition is unvaryingly fatal unless immediate treatment is provided. An alternative to complete cardiac transplantation is surgical reconstruction of the neonatal circulation performed in three separate stages. The intent of the initial surgical stage, referred to as the Norwood procedure, is to achieve adequate blood flow in both the systemic and pulmonary vascular beds with only one functional ventricle. The purpose of this study was to develop a comprehensible, software-based model of the Norwood circulation that can be used to improve understanding of the complex physiology resulting from the palliative operation. To accomplish this, a previously documented mathematical model of the Norwood circulation was implemented as a graphical user interface in Simulink, thus forming a user-friendly software environment for efficient quantitative and qualitative hemodynamic analysis. Published clinical data obtained from Norwood operation patients were utilized for model validation. Simulation of the Simulink model produced results that correlate well with the clinical data and with information found in the literature, indicating that the model is a valid tool for studying trends and behaviors associated with the Norwood circulation. Specifically, the model may be useful for analyzing hemodrynamic responses to various inputs, exploring prospective treatment methods prior to clinical experimentation, and comparing different surgical strategies. Additionally, the model may be an effective preoperative planning aid, particularly in a case consisting of unique or unfamiliar patient physiology. A further objective of this research was to adjust the Norwood model so that it represents the pediatric circulation following the Sano modification, which is an alternative option for first-stage palliation of hypoplastic left heart syndrome, and to simulate the experimental model as a preliminary investigation of system performance. The results of the simulation, which show consistency with pertinent research reports, imply that constructing a valid model of the Sano modification from the Simulink model of the Norwood circulation described in this study is a viable path for future research. |
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