38. Ticagrelor Removal With Intraoperative Polymer Bead Hemoadsorption in Patients Undergoing Urgent Coronary Artery Bypass Grafting
Weill Cornell Medicine/NYP Hospital
New York, NY
United States - Contact Me
Dr. Mario Gaudino is the Stephen and Suzanne Weiss Professor (II) in Cardiothoracic Surgery in the Department of Cardiothoracic Surgery at NYPresbyterian/Weill Cornell Medical Center.
In addition to his clinical expertise, Dr. Gaudino is currently the Assistant Dean for Clinical Trials, Director for the Joint Clinical Trials Office (JCTO), and the Director of Translational and Clinical Research for the Department of Cardiothoracic Surgery. He is currently the lead investigator of several international, randomized, cardiac surgery trials (ROMA, ROMA:Women, RECHARGE, STICH3C, SITCOS, ODIN, PALACS, EPIC).
Throughout his academic career, Dr. Gaudino has published more than 730 peer-reviewed manuscripts in cardiothoracic surgery, cardiology and research methodology and public health in high impact journals including first author in NEJM, the Lancet and JAMA along with numerous book chapters. He currently serves as the Chair of the of the Council on Cardiovascular Surgery and Anesthesia CVSA Education and Publications Committee as well as the Chair of the Participant User File (PUF) Review Task Force of the Society of Thoracic Surgeons (Adult Cardiac Subcommittee). He has also recently been appointed Councilor at Large of the European Association for Cardio-thoracic Surgery.
Dr. Gaudino is a well-known advocate for scientific integrity and surgical quality. He frequently serves on guideline writing committees to establish standards for cardiac surgery at both national and international levels. Currently, he is a member of the AHA/ACC Joint Committee on Clinical Practice Guidelines.
Dr. Gaudino's interrests include all asbects of adult cardiac surgery. Along with his expert training and knowledge in coronary artery bypass surgery, including the use of multiple arterial grafting (radial artery conduits, the use of bilateral internal mammary arteries). Dr. Gaudino also specializes in structural heart disease, valvular dysfunction and complex aortic procedures.
Asklepios Klinik St. Georg
Hamburg, Germany
United States - Contact Me
Born 1963 in Stuttgart, Germany
Medical studies at the Universities of Tuebingen and Munich (LMU) 1982-1988
Training in Cardiac Surgery Dept. of Cardiac Surgery, Klinikum Großhadern, LMU Munich 1990-1996 (Prof. Bruno Reichart)
Research in xenotransplantation, Papworth Hospital (Mr. John Wallwork) 1996-97
Specialist in Cardiac Surgery 2000
Consultant (LMU Munich) 2001
Senior Consultant 2007
Head of Department of Cardiac Surgery, AK St. Georg, Hamburg since 2009
Description
Methods: The hemoadsorption cartridge was incorporated in the CPB circuit and remained active for the duration of the pump run. Blood samples were collected before and after CPB. The main objective of the current analysis was to compare mean total plasma ticagrelor levels (ng/mL) at baseline with ticagrelor levels obtained at the end of CPB. Plasma ticagrelor levels were measured at a certified outside laboratory (Altascience, Laval, QC, Canada). Data are presented as mean ± SD.
Results: A total of 11 patients undergoing urgent CABG at 3 institutions were included (mean age 67.9±9.8 years, 91% male, mean EuroSCORE-II of 3.0±3.3% (range: 0.7-12.4%). Mean intraoperative hemoadsorption duration was 97.1±43.4min with a mean flow rate through the device of 422.9±40.3mL/min. Mean ticagrelor levels pre-CPB were 103.5±63.8ng/mL compared with mean post-CPB levels of 34.0±17.5ng/ml, representing a highly significant 67.1% reduction (P<0.001, Figure). Sites reported that the intraoperative integration of the device was simple and safe without any device-related adverse events reported.
Conclusions: This is the first in vivo report demonstrating that intraoperative hemoadsorption can efficiently remove ticagrelor and significantly reduce circulating drug levels. Whether active ticagrelor removal can reduce serious perioperative bleeding in patients undergoing urgent cardiac surgery is currently evaluated in the double blind, randomized Safe and Timely Antithrombotic Removal – Ticagrelor (STAR-T) trial.