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Pediatric Cardiology

, Volume 34, Issue 1, pp 119–124 | Cite as

Decreasing the Need for Transfusion: Infant Cardiac Surgery Using Hemodilution and Recombinant Factor VIIa

  • Peter D. WinchEmail author
  • Aymen N. Naguib
  • Jacob R. Bradshaw
  • Mark Galantowicz
  • Joseph D. Tobias
Original Article

Abstract

Many strategies, including intraoperative acute normovolemic hemodilution (ANH) and pharmacologic agents, exist to minimize the use of allogeneic blood products in pediatric congenital heart surgery. Recombinant activated factor VIIa (rFVIIa) is a hemostatic agent approved for the treatment of bleeding episodes and prevention of bleeding in surgical interventions in patients with hemophilia A or B with inhibitors, acquired hemophilia, or congenital factor VII deficiency. Off-label use in nonhemophilic patients for uncontrolled hemorrhage is increasing although still under investigation. We present our experience with ANH and rFVIIa in nine patients. All were <16 months of age and underwent complex cardiac surgery with the end point of achieving hemostasis while decreasing or eliminating the need for allogeneic blood products. Clinically, we have observed rapid hemostasis in patients who underwent ANH and then had autologous blood reinfused after cardiopulmonary bypass, along with rFVIIa, without any time delay. The patients required no allogeneic blood products and therefore results suggested the potential utility of this practice. The study group consisted of nine patients <16 months of age who received rFVIIa in the operating room after open-heart surgery. Amount of autologous blood removed preoperatively, blood product use, time from protamine to rFVIIa administration, platelet count, INR, and fibrinogen level were retrospectively obtained. Of the nine patients, the three who underwent the most aggressive hemodilution received rFVIIa most rapidly and required no allogeneic blood products to achieve hemostasis although they had an average lower fibrinogen level on admission to the cardiothoracic intensive care unit. These preliminary data suggest that hemodilution before surgical stimulation and the rapid administration of rFVIIa, along with the reintroduction of autologous blood, may decrease or potentially eliminate the need for allogeneic blood products. Prospective trials are warranted to further explore this technique.

Keywords

Neonatal congenital cardiac surgery Recombinant factor VIIa Decrease transfusion 

Notes

Acknowledgments

The authors acknowledge Vincent Olshove, Denise Bennett, Daniel Gomez, and Jeff Burnside for their help with patient care and data collection; Julie Rice and S. Townsend for data collection; and Y. Miao for statistical analysis.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Peter D. Winch
    • 1
    Email author
  • Aymen N. Naguib
    • 1
  • Jacob R. Bradshaw
    • 2
  • Mark Galantowicz
    • 3
  • Joseph D. Tobias
    • 4
  1. 1.Department of Anesthesiology and Pain Medicine and The Heart CenterNationwide Children’s HospitalColumbusUSA
  2. 2.The Ohio State University College of MedicineColumbusUSA
  3. 3.Department of Cardiothoracic Surgery and The Heart CenterNationwide Children’s HospitalColumbusUSA
  4. 4.Department of Anesthesiology and Pain MedicineNationwide Children’s HospitalColumbusUSA

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