Abstract
Postoperative bleeding might become a serious problem in the management of cardiac surgical patients, with marked medical and economic impact. In these life-threatening situations, massive haemorrhage represents frequently a combination of surgical and coagulopathic bleeding. Surgical bleeding results from a definite source at the operation site and can be corrected using surgical standard techniques. Acute coagulopathies, in contrast, result from impaired thrombin formation, and require optimized therapeutical strategies. Effective pharmacological treatment will be complicated by the presence of ventricular assist devices (VAD), which necessarily imply effective anticoagulation.In episodes of uncontrolled coagulopathic bleeding, the application of recombinant activated factor VII (rFVIIa) as a effective haemostatic agent has become more and more popular. However, only very few data are available on its use in patients with VAD in place.We researched the PubMed-database for case reports about the use of rFVIIa in patients with VAD and summarized them. In addition, we report a case from our hospital. In all cases cessation of bleeding without any thrombembolic complications could be achieved. In cases of uncontrollable, non-surgical bleeding rFVIIa seems to be a therapeutical option even for patients with VAD.
Highlights
Over the last decade, the impact of ventricular assist devices (VAD) in the treatment of end-stage cardiac failure has been increasingly recognized
We report the application of rFVIIa in a patient with a biventricular assist device (BIVAD) in order to treat massive non-surgical bleeding, and present a review on the current literature
A right-ventricular assist device (RVAD) was implanted, and extracorporal circulation could be stopped without complications
Summary
The impact of ventricular assist devices (VAD) in the treatment of end-stage cardiac failure has been increasingly recognized. A right-ventricular assist device (RVAD) was implanted, and extracorporal circulation could be stopped without complications After this emergency procedure, the patient was transferred to the surgical ICU in stable haemodynamic conditions. The patient was continuously and massively bleeding, with a blood loss of > 500 mL per 15 minutes It was necessary transfuse 10 units of red blood cells (RBC), 7 units of frozen plasma (FFP) and 10 units of platelet concentrate (PC), and to substitute 3000 I.U. of prothrombin complex (PPSB), 3000 I.U. of antithrombin and 6 g of fibrinogen immediately after arrival on the ICU. Despite these efforts, massive blood loss persisted and a re-thoracotomy was performed at the bedside. The decision was made to stop any therapeutical efforts, and VADs were switched off leading to an immediate circulatory arrest
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