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  • Title: Synthetic antifibrinolytics are not associated with an increased incidence of baffle fenestration closure after the modified Fontan procedure.
    Author: Gruber EM, Shukla AC, Reid RW, Hickey PR, Hansen DD.
    Journal: J Cardiothorac Vasc Anesth; 2000 Jun; 14(3):257-9. PubMed ID: 10890476.
    Abstract:
    OBJECTIVE: To determine if the lysine analog antifibrinolytic agents, epsilon-aminocaproic acid and tranexamic acid, are associated with early closure of the baffle fenestration after the modified Fontan procedure. DESIGN: Retrospective chart review. SETTING: University hospital. PARTICIPANTS: Seventy-four successive patients underwent the modified Fontan procedure. Three patients received aprotinin and were excluded. A total of 71 patients were analyzed. INTERVENTIONS: Charts were examined for variables known to be associated with baffle fenestration closure in the modified Fontan procedure. MEASUREMENTS AND MAIN RESULTS: Occurrence of baffle fenestration closure, oxygen saturation, central venous pressure, left atrial pressure, transpulmonary gradient, chest tube drainage volume, chest tube drainage duration, intensive care unit (ICU) duration, and total inpatient duration were compared between the 33 patients who received antifibrinolytics and the 38 patients who did not. One patient of 71 had baffle fenestration closure in the first 48 hours after surgery. Oxygen saturation, central venous pressure, left atrial pressure, transpulmonary gradient, chest tube drainage volume, chest tube drainage duration, days in ICU, and total inpatient duration were not significantly different between the two groups. CONCLUSIONS: Use of epsilon-aminocaproic acid and tranexamic acid is not associated with early baffle fenestration closure after the modified Fontan procedure. It is concluded that these agents can be used without increasing the risk of spontaneous baffle fenestration closure.
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