0378: Mechanical circulatory support and factor VII: effective but (not so) dangerous?

Abstract

Hemorrhagic complications are a main concern after mechanical circulatory support, alternative to heart transplantation, and often involve multiple transfusions and re-interventions at the initial phase. The Recombinant activated factor VII (NovoSeven®), expensive drug with proven blood savings in some coagulopathies, can help control mediastinal bleeding but runs the risk of pump thrombosis. This is a single-center prospective cohort of patients wtih longterm electrical intracorporeal continuous flow left ventricular assist device (LVAD) type HeartMate II, between January 2008 and September 2014. We studied the post-operative use of blood products and their derivatives, especially NovoSeven®, and its consequences on the level of bleeding and thromboembolism. 42 devices were implanted in 36 men and 6 women with a mean age of 57.3 years, for 30 ischemic and 12 primitive cardiomyopathies, 10 cases in “Destination Therapy” and 32 in “Bridge-to-Transplantation”. The 30-day mortality was 6 patients, 1-year survival of 84%, the average intubation period of 7 days and ICU stay of 16.3 days. The average volume of thoracic drainage was 3036mL. The average transfusion per patient was 10.4 red blood cells, 7.1 fresh frozen plasma, 16.3 platelet units, 2.4g of fibrinogen (Clottafact®), 1162 IU of clotting factors (Octaplex®) and 2.9g of NovoSeven®. 17 patients (40.5%) received NovoSeven® (ranging from 4 to 15mg) including 8 during the procedure because of precarious hemostasis. Only 6 patients (14.3%) required reoperation for tamponade within J0 and J9, including 4 who had NovoSeven® prior. 6 patients (14.3%) had an intracardiac thrombus remote, 3 had received NovoSeven®. An aggressive transfusion policy after LVAD can greatly limit the rate of surgical re-openings for bleeding, recognized as a risk factor for wound infection, without causing major thrombotic event.