The hemostatic history of a 15-month-old child implanted with a Berlin heart left ventricular assist device
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Published on: July 18, 2014
Brad L Steenwyk1, James K Kirklin, William Q Gurley
1Department of Anesthesiology, The University of Alabama at Birmingham, Birmingham, AL 35294-2172, USA.
Insights
Placement of a Berlin Heart ventricular assist device rapidly induced hypercoagulability in a pediatric patient, requiring significant blood products for hemostasis despite aggressive anticoagulation. Careful management is crucial for patient safety.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Hematology
Background:
- Left ventricular assist devices (LVADs) like the EXCOR Berlin Heart are critical for pediatric end-stage heart failure.
- Understanding hemostatic changes is vital for managing patients awaiting heart transplantation.
Observation:
- A 15-month-old child received an EXCOR Berlin Heart LVAD prior to heart transplantation.
- Hemostatic status was monitored throughout the peri-operative period.
Findings:
- Rapid development of hypercoagulability was observed, characterized by increased plasmatic and platelet-mediated coagulation kinetics and strength.
- This hypercoagulable state persisted for several weeks post-implantation.
- The patient experienced no thrombotic complications but required substantial blood product support to maintain hemostasis due to aggressive anticoagulation.
Implications:
- Anesthetic and surgical management protocols for Berlin Heart patients must account for potential hypercoagulability.
- Careful consideration of anticoagulant therapy is essential to balance bleeding risk and thrombotic prevention.
- Optimizing hemostatic management is critical for improving patient safety and outcomes in pediatric LVAD recipients.
Abstract:
We documented the hemostatic changes associated with placement of a EXCOR Berlin Heart left ventricular assist device in a 15-month-old child before heart transplantation. The development of hypercoagulability was rapid, manifested first by a plasmatic and subsequently platelet-mediated increase in coagulation kinetics and strength that persisted for weeks. The patient had no thrombotic complications for 6 wk before transplant but required extraordinary blood product administration to achieve hemostasis secondary to aggressive, multimodal anticoagulation. In summary, when proscribing anesthetic and surgical management of patients with a Berlin Heart, consideration of hypercoagulable features and anticoagulant therapy must be made to maximize patient safety.
