[HSF] aortic root replacement ,svere hyperbilirubinemia

[erdinç naseri]

Dear  members ,
opinion requested regarding the following case:
70 y/o  heavy smoker ( 80 years-pack)male with  severe AR and root dilatation( annulus 5.7 ,valsalva 6.2,STJ 6.1,ascending aorta 5.6,EF good),Preop Spo2 92%,Htc 52%.No history of any defect of bilirubin metabolism. 
Aortic root replacement with cabrol modification( hand made valved conduit,carbomedics + vascutek),Xclamp 108 ,CPB 175,minimal dopamine on weaning,oozing which didn't decreased by fresh blood and FFP ( no platelets available),packed with sponges and taken to ICU.
Hematuric urine which resolved  in hours,no important drainage.Postop day 1 reopened and depacked .started bleeding from two deairing needle holes which resolved by hot sponge application.Reclosure and no bleeding untill evening . Evaluated for extubation and decided to give one unit of rbc and then extubate.(Htc 27 %, Spo2 90% on T tube).One unit given with no increase in Htc ,2.nd unit and then bilirubin stared rising to 7 same night 15 the next morning, 25 postop 2.nd day and 37 3.rd day.Creatinine up to 4 and then down to 2.8 today(direct bilirubin >60%,LDH 2000,AST 160,ALT 45,INR 1.57).Extubated and oriented but sleepy.Hemodynamics stable and in AF (NSR preop which converted toAF on postop 2.nd day)
Bilirubin is going up. Comments
erdinc