Case reportsUse of recombinant factor VII to control bleeding in a patient supported by right ventricular assist device after heart transplantation
Section snippets
Case report
A 48-year-old patient with ischemic cardiomyopathy underwent heart transplantation. Before operation the patient received Capoten 150 mg/day, Frusemid 120 mg/day, Aldacton 50 mg/day, Digoxin 0.125 mg/5 days per week, and Cartia 100 mg/day. Pulmonary pressure was normal; ejection fraction was 16%, and coagulation tests were within normal limits (see Table 1). Ischemic time was 3 hours 20 minutes. The transplantation was technically uneventful; cross-clamping time was 82 minutes. After the
Discussion
Right heart failure after heart transplantation is a life-threatening complication. When conventional therapy fails, implantation of a RVAD may be the only way to achieve a good hemodynamic status. Massive bleeding after prolonged cardiopulmonary bypass and ventricular assist device implantation occurs in 6.6% of patients and is associated with a high morbidity and mortality rate.6 CPB can aggravate hemostasis by activating fibrinolysis, impairing platelets, and affecting coagulation factors.
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