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J Thorac Cardiovasc Surg 2002;123:384-385
© 2002 The American Association for Thoracic Surgery

Brief Communications

Successful use of activated recombinant factor VII to control bleeding abnormalities in a patient with a left ventricular assist device

Mirosaw Zitkiewicz, MD, Mirosaw Garlicki, MD, PhD, Jerzy Domagaa, MD, Karol Wierzbicki, MD, Rafa Drwia, MD, PhD, Roman Pfitzner, MD, PhD, Antoni Dziatkowiak, MD, PhD Kraków, Poland

From the Department of Cardiovascular Surgery and Transplantation, Institute of Cardiology, Collegium Medicum, Jagiellonian University, Kraków, Poland.

Received for publication May 17, 2001. Accepted for publication July 27, 2001. Address for reprints: Mirosaw Zietkiewicz, MD, Department of Cardiovascular Surgery and Transplantation, Institute of Cardiology, John Paul II Hospital, Ul. Prdnicka 80, 31-202 Kraków, Poland (E-mail: miro_z@inetia.pl).

Bleeding is the most frequent complication related to implantation of a mechanical cardiac assist device. ¹ Recombinant activated factor VII (NovoSeven; Novo Nordisk, Bagsvaerd, Denmark) was developed as a prohemostatic agent. We report the successful use of recombinant activated factor VII to control bleeding abnormalities in a patient with a left ventricular assist device (LVAD).

Clinical summary
After repeated cardiac surgery (mitral and later tricuspid annuloplasty, implantation of a mechanical mitral valve, and subsequent reimplantation of an artificial mitral valve), a 34-year-old male patient was admitted to the cardiac surgical intensive care unit with severe left ventricular dysfunction. Hemostatic disturbances were also observed, with the following initial coagulation parameters: international normalized ratio (INR) 2.22, antithrombin III 48.84%, platelet count 35 x 10⁹/L, and a negative result of the D-dimers test (<200 µg/L).

Cardiac shock developed despite high and increasing doses of inotropic agents. To unload the failing heart and prevent the patient's condition from deteriorating into multiple organ failure, we implanted a pneumatically driven, diaphragm-type LVAD . . . [Full Text of this Article]

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