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J Thorac Cardiovasc Surg 2007;134:1053-1054
© 2007 The American Association for Thoracic Surgery

Brief Communication

Fatal thrombosis in complex cardiac surgery without deep hypothermic circulatory arrest in the setting of standard-of-care heparinization: Status quo and directions for further research

Cardiothoracic Section, Anesthesiology and Critical Care, Hospital of the University of Philadelphia, Philadelphia, Pa.

Received for publication June 6, 2007; accepted for publication June 21, 2007.

^_* Address for reprints: John G. T. Augoustides, MD, FASE, Assistant Professor, Cardiothoracic Section, Anesthesiology and Critical Care, Dulles 680, Hospital of the University of Philadelphia, 3400 Spruce St, Philadelphia, PA 19104-4283. (Email: yiandoc@hotmail.com).

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Fatal thrombosis in complex cardiac surgery without deep hypothermic circulatory arrest was highlighted in a case report of biventricular assist device placement complicated by aortic cannula thrombosis and subsequent fatal cerebral infarction.¹ The risk factors identified in this case were aprotinin exposure and stasis of blood in the aortic cannula after protamine administration. Despite standard-of-care heparinization, this syndrome has persisted, as evidenced by a series of case reports (n = 4: 1996-2006).^1-4 The purpose of this brief communication is to review this cumulative case series to guide further investigation. The literature search was conducted with PubMed (last entry May 31, 2007) with the following search terms: thrombosis and cardiac surgery; aprotinin and thrombosis in cardiac surgery; aminocaproic acid and thrombosis in cardiac surgery; tranexamic acid and . . . [Full Text of this Article]