The authors present the diagnostic and therapeutic management in
bleeding episodes associated with cardiosurgical operations, which constitutes the policy that is employed at Department of Cardiac Surgery and Transplantology, Silesian Academy of Medicine, Zabrze, Poland. The paper also presents a compendium of information on the pathophysiology of coagulation processes, most significant from the standpoint of cardiosurgical practice. Separate issues associated with providing optimal hemostasis in patients operated on using
cardiopulmonary bypass are discussed, along with the effect of cardiac procedures on coagulation processes. Further, the authors present their clinical observations and experience in the utilization of the recombinant
activated factor VII (
NovoSeven, NovoNordisk) in two patients with severe perioperative
bleeding. In the first case
bleeding was associated
heart transplantation procedure in a 37-year old woman, who had previously been twice subjected to operations for
valvular heart disease. A dysfunction of two artificial valves implanted 15 years previously resulted in considerable heart muscle damage and an extremenally severe form of cardiac insufficiency. Two months after the heart transplant the patient unfortunately died due to infectious complications. In the second patient the recombinant
activated factor VII was employed in an attempt at controlling severe
bleeding encountered in a 15-year old boy in the course of reoperation in surgical treatment of a complex
congenital heart defect. In this case the treatment was successful. In both described patients who were characterized by a high risk of surgical
bleeding, the employment of the recombinant
activated factor VII led to significant improvement in coagulation system indices and the
hemostatic outcome was regarded positive. The authors state that the introduction of the recombinant
activated factor VII to clinical practice in a selected group of patients presenting with most serious coagulation abnormalities and difficult to control perioperational
bleeding allows for improving therapeutic results and decreasing mortality in cardiac surgery patients. In view of the significant economic barrier associated with a high cost of the preparation, the authors propose a consistent approach of employing at all times the classic, well-balanced
hemostatic management, based primarily on extended knowledge of the pathophysiology of the clotting system and on very thorough
surgical hemostasis, with the recombinant
activated factor VII being reserved for exceptional situations only.