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J Thorac Cardiovasc Surg 2004;128:941-943
© 2004 The American Association for Thoracic Surgery

Brief Communications

Successful use of one dose of recombinant factor VIIa to control severe bleeding after emergency aortic arch replacement in deep hypothermic circulatory arrest

^a Department of Anesthesiology, University Hospital of Regensburg, Regensburg, Germany
^b Department of Cardiothoracic and Vascular Surgery, University Hospital of Regensburg, Regensburg, Germany

Received for publication March 2, 2004; revisions received March 12, 2004; accepted for publication March 18, 2004.

^* Address for reprints: Christoph Wiesenack, MD, Department of Anesthesia, University Hospital, Franz-Josef-Strauss Allee 11, 93052 Regensburg, Germany
christoph.wiesenack@klinik.uni-regensburg.de

The first 20% of the full text of this article appears below.

Postoperative bleeding is a common complication after prolonged cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA).¹ Experience in the off-label use of recombinant factor VIIa (rFVIIa) after cardiac surgery under the condition of DHCA is very limited, but a recent report demonstrated its efficacy in a case of life-threatening bleeding after elective aortic arch repair in a patient without preexisting hemorrhagic diathesis.² We report a case of successfully using rFVIIa in the treatment of severe intractable bleeding after emergency ascending and arch replacement for acute type A aortic dissection with prolonged CPB and DHCA in a patient who received antiplatelet drugs.

	Clinical summary

 
A 57-year-old man was admitted to another hospital for investigation into back pain and a short episode of unconsciousness. Echocardiogram showed ST-segment elevation in the posterior and inferior leads, and the patient received heparin 10,000 IU and aspirin 500 mg (acetylsalicylic acid) for presumed myocardial infarction. Transesophageal echocardiography, however, demonstrated a type A aortic dissection associated with a severe aortic valve insufficiency, and the patient was intubated and referred to our center for surgical treatment.

On admission, the patient's hemodynamic situation was stable under vasoactive support with norepinephrine (0.05 µg · kg^–1 · min^–1). Initial coagulation parameters were normal: international normalized ratio, 1.2; activated partial thromboplastin time, 37 seconds; and platelet count, 212 x 10⁹/L. Chest computed tomographic findings confirmed the diagnosis and showed a dissection that reached from the aortic valve to the femoral arteries. During investigation, the patient's hemodynamic state deteriorated, and he was taken . . . [Full Text of this Article]