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

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Abstract

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.

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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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