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Cardiac surgery and catheterization in patients with haemophilia
N MacKinlay1, J Taper, F Renisson
1Haemophilia Centre, Institute of Haematology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown NSW 2050, Australia.
Insights
Cardiac surgery in patients with Haemophilia A and B is safe and effective. Procedures like bypass surgery and valve replacement were successfully performed with excellent haemostasis using factor concentrates.
Area of Science:
- Cardiology
- Hematology
Background:
- Patients with Haemophilia A and B present unique challenges for cardiac surgery due to their coagulation disorder.
- Managing bleeding risk is paramount in these patients undergoing invasive cardiac procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of cardiac surgical procedures in patients with Haemophilia A and B.
- To assess the management of haemostasis during and after these interventions.
Main Methods:
- A retrospective review of 12 cardiac surgical procedures in 7 patients with Haemophilia A and 1 patient with Haemophilia B.
- Procedures included cardiac catheterization, coronary artery bypass surgery, angioplasty, valve replacement, and atrial septal defect closure.
- Haemostasis was managed with activated human plasma (AHF) or high-purity factor IX concentrate (Immunine), with evolving administration from bolus to continuous infusion.
Main Results:
- All patients achieved excellent intra- and post-operative haemostasis.
- No demonstrable inhibitors were present at the time of surgery.
- Various cardiac procedures were performed successfully, with no major bleeding complications reported.
Conclusions:
- Cardiac surgical procedures can be performed safely in patients with Haemophilia A and B.
- Effective haemostasis can be achieved using factor concentrates, with continuous infusion potentially offering advantages.
Abstract:
The present study summarizes the results of 12 cardiac surgical procedures performed in a carrier of Haemophilia B and in six patients with Haemophilia A at a single centre from 1979 to 1998. The median age of the patients at the time of intervention was 56 years ranging from 18 years to 73 years. The six patients with Haemophilia A ranged in severity from moderately to mildly affected. Three patients were hepatitis C antibody positive. No patients were HIV antibody or hepatitis B surface antigen positive. The cardiac procedures included cardiac catheterization (n=4), coronary artery bypass surgery (n=2), percutaneous transluminal coronary angioplasty (n=1), cardiac valve replacement (AVR n=1 and AVR/MVR n=2), and closure of an atrial septal defect and subsequent drainage of a pericardial effusion (n=1). No patients had demonstrable inhibitors at the time of surgery. Haemostasis was achieved with AHF in 10/11 procedures and high purity factor IX (Immunine) in one procedure. The initial procedures involved intermittent bolus factor therapy while more recently, AHF was administered by continuous intravenous infusion. All patients demonstrated excellent intra- and post-operative haemostasis. These results, although from a small and varied group of patients, demonstrate that cardiac surgical procedures can be performed safely in patients with Haemophilia.