Use of recombinant factor VII to control bleeding in a patient supported by right ventricular assist device after heart transplantation.

A 48-year-old man undergoing orthotopic heart transplantation for ischemic cardiomyopathy developed severe right heart failure. Severe intractable bleeding complicated implantation of a right ventricular assist device. Treatment with 9.6 mg of recombinant activated factor VII stopped the bleeding, and the patient could be transferred to the intensive care unit. This is the first reported case of the successful use of recombinant activated factor VII to control bleeding with subsequent right ventricular assist device function.     

Activated recombinant factor VII for control of diffuse bleeding after implantation of ventricular assist device

Patients with prolonged severe cardiogenic shock requiring implantation of a biventricular assist device may develop diffuse bleeding due to alteration of hepatic and renal function and subsequent coagulopathy. Bleeding control in these patients may be difficult despite massive use of blood products. We report on the successful use of recombinant activated factor VII for control of massive bleeding after implantation of a biventricular assist device in a patient with prolonged severe cardiogenic shock.     

Continuous infusion of recombinant activated factor VII for bleeding control after lobectomy in a patient with inherited factor VII deficiency

Inherited factor VII (FVII) deficiency is a rare recessive inherited coagulation disorder with limited available information, especially in patients undergoing major thoracic surgery. In addition, an optimal management strategy for the disease has not been defined. We herein report a case involving a 61-year-old man with asymptomatic FVII deficiency who underwent a right middle and lower lobectomy to treat lung cancer. To the best of our knowledge, the present report is the first to describe the use of recombinant activated FVII continuous infusion for bleeding control after a major thoracic surgery in a patient with inherited FVII deficiency.     

Successful use of recombinant activated coagulation factor VII in a patient with massive hemoptysis from a penetrating thoracic injury

Acute massive hemoptysis is a rare complication of pulmonary injury and contusion, and it is particularly difficult to manage in the nontertiary care setting. Recombinant activated coagulation factor VII (rFVIIa) is a prothrombotic drug that is increasingly being used to treat coagulopathy in massively exsanguinating trauma patients. We report a case in which recombinant activated coagulation factor VII successfully controlled massive hemoptysis and improved ventilation from a severe pulmonary contusion in a noncoagulopathic patient who suffered a penetrating thoracic injury in a military setting in Afghanistan.     

Use of activated recombinant factor VII for severe coagulopathy post ventricular assist device or orthotopic heart transplant

Background  

Ventricular assist devices(VAD) implantation/removal is a complex surgical procedure with perioperative bleeding complications occurring in nearly half of the cases. Recombinant activated factor VII (rFVIIa) has been used off-label to control severe hemorrhage in surgery and trauma. We report here our experience with rFVIIa as a rescue therapy to achieve hemostasis in patients undergoing orthotopic heart transplant (OHT) and/or VAD implantation.     

Acute left atrial thrombus after recombinant factor VIIa administration during left ventricular assist device implantation in a patient with heparin-induced thrombocytopenia

We present a patient with end-stage heart failure and heparin-induced thrombocytopenia Type II, who required cardiopulmonary bypass (CPB) during a repeat implantation of a left ventricular assist device for long-term circulatory support. Bivalirudin was selected for anticoagulation during CPB, with concomitant infusion of aprotinin, in an effort to ameliorate blood loss. Nonetheless, profuse bleeding after CPB required massive transfusion of packed red blood cells, multiple coagulation factors, and platelets. Because of persistent bleeding, a single dose of recombinant factor VIIa (rFVIIa, 7.2 mg) was administered as rescue therapy. Within minutes, a large left atrial thrombus was detected by transesophageal echocardiography. We believe this is the first documentation of acute left atrial thrombus formation immediately after a single dose of recombinant factor VIIa administration during a left ventricular assist device implantation.     

The use of recombinant activated factor VII to control bleeding during repair of a suprarenal abdominal aortic aneurysm.

Recombinant activated factor VII (rFVIIa) was first used to control bleeding in haemophilia patients. More recently, it has been used to prevent severe bleeding in patients without pre-existing coagulopathy. We report a case where rFVIIa was used to successfully control postoperative bleeding in a patient undergoing suprarenal abdominal aortic aneurysm (AAA) repair.     

Successful management of COVID-19 and associated coagulopathy in a patient with durable left ventricular assist device

Patients with durable left ventricular assist devices pose special problems for management in the setting of COVID-19 infection. We describe the successful management of a 44-year-old man with severe COVID-19 infection and HeartMate 3 left ventricular assist device. His course was complicated by cytokine storm and COVID-19-associated coagulopathy. We describe our institutional protocol for managing COVID-19 infection in patients on mechanical circulatory support, focusing on the need for a thoughtful, multidisciplinary approach.     

Late aortic dissection in a patient with a left ventricular assist device

The limited availability of donor hearts means that an increasing number of transplantation candidates are temporarily or permanently supported by mechanical circulatory assist devices. We report a patient undergoing implantation of a Novacor left ventricular assist device who suffered fatal aortic dissection on postoperative day 11 after satisfactory recovery from multiple organ failure. The dissection of the aorta initially presented as an embolic peripheral ischemia. Early complete echocardiography is thus warranted to rule out dissection.     

Laparoscopic cholecystectomy in a patient with an implantable left ventricular assist device

Left ventricular assist devices (LVADs) provide mechanical supportfor left ventricular ejection in the failing heart. We describethe anaesthetic management of a patient with an LVAD requiringlaparoscopic cholecystectomy. A 51-yr-old female patient withsevere heart disease had a Heartmate II LVAD implanted 4 monthsbefore this proposed elective surgery. Maintaining haemodynamicstability in the perioperative period is essential in such patients.The case was managed successfully using invasive monitoringand anaesthesia with sevoflurane and remifentanil. The potentialproblems in management of patients with LVADs are highlightedand discussed. A team approach is essential.