Aortic dissection and hypothermic arrest in a Jehovah's Witness patient: a case for recombinant factor VIIa?
OBJECTIVE
To present a case of survival of a cognitively intact Jehovah's Witness patient with an aortic dissection who underwent hypothermic arrest. Recombinant factor VIIa, but no blood products were administered.


METHODS
An 83-yr-old female with an acute type A aortic dissection underwent emergent surgical repair. Proximal extension of the dissection necessitated prolonged cardiopulmonary bypass (CPB) and hypothermic circulatory arrest. Despite this, perioperative hemostatis was adequate. Recombinant factor VIIa 90 microg x kg(-1) i.v. was administered post-CPB. The patient had an uneventful postoperative course, and was discharged home neurologically intact.


CONCLUSIONS
Patients who conscientiously object to the transfusion of blood products may present a considerable anesthetic challenge, especially those at risk from coagulopathy associated with CPB and hypothermic circulatory arrest. Recombinant factor VIIa may play a role in hemostasis management of these individuals, however, well-designed randomized controlled trials need to be undertaken to establish the efficacy and risks related to this potential indication.
Department of Anesthesia, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
Jenifer
J
Ballen
Michael
M
Raabe
Brian
B
Muirhead
D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D004305:Dose-Response Relationship, Drug; D017548:Echocardiography, Transesophageal; D005167:Factor VII / Q000627:therapeutic use*; D015942:Factor VIIa; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D033221:Jehovah's Witnesses; D011994:Recombinant Proteins / Q000627:therapeutic use; D016896:Treatment Outcome
D006490:Hemostatics; D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa