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Mitral valve reconstruction in sickle cell disease
F D Pagani1, R J Polito, S F Bolling
1Department of Surgery, University of Michigan Hospitals, Ann Arbor 48109, USA.
The Annals of Thoracic Surgery
|June 1, 1996
Summary
Successful cardiac surgery is possible for older sickle cell anemia patients. Management included exchange transfusion to lower hemoglobin S levels during cardiopulmonary bypass for mitral valve repair.
Area of Science:
- Cardiology
- Hematology
- Anesthesiology
Background:
- Increasing survival rates in sickle cell anemia patients necessitate advanced cardiac surgical interventions.
- Sickle cell disease (SCD) poses unique challenges during cardiopulmonary bypass due to hemoglobin S.
- Older patients with SCD are increasingly candidates for cardiac procedures.
Observation:
- A 52-year-old patient with homozygous sickle cell disease and a history of crisis underwent mitral valve repair.
- The patient required cardiopulmonary bypass for the cardiac surgical procedure.
Findings:
- Successful management was achieved through a combination of preoperative and intraoperative exchange transfusions.
- Hemoglobin S levels were reduced to 5.4% during cardiopulmonary bypass.
- Key surgical management strategies included high-flow normothermic bypass, aortic crossclamping, topical hypothermia, and cold crystalloid cardioplegia.
Implications:
- This case demonstrates the feasibility of complex cardiac surgery in older SCD patients.
- Effective perioperative strategies can mitigate risks associated with hemoglobin S during bypass.
- Highlights the importance of multidisciplinary management for SCD patients undergoing major surgery.