Intraoperative use of recombinant activated factor VII during complex aortic surgery

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 143; no. 5; pp. 1198 - 1204
• Main Authors: Goksedef, Deniz, MD, Panagopoulos, Georgia, PhD, Nassiri, Naiem, MD, Levine, Randy L., MD, Hountis, Panagiotis G., MD, Plestis, Konstadinos A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2012; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; Biological and medical sciences; Bleeding; Blood products; Blood Transfusion; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Cardiology. Vascular system; Cardiothoracic Surgery; Chest; Coagulation factors; Drug Administration Schedule; Erythrocytes; Factor VIIa - administration & dosage; Factor VIIa - adverse effects; Female; Hemostatics - administration & dosage; Hemostatics - adverse effects; Hospitals; Humans; Intensive Care Units; Intraoperative Care; Intubation; Length of Stay; Logistic Models; Male; Medical sciences; Middle Aged; Morbidity; Mortality; New York City; Pneumology; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - mortality; Postoperative Hemorrhage - prevention & control; Propensity Score; Recombinant Proteins - administration & dosage; Recombinant Proteins - adverse effects; Registries; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Surgery; Thorax; Thrombosis - etiology; Time Factors; Treatment Outcome; Young Adult; POD; postoperative day; 16; fresh-frozen plasma; PRBC; deep hypothermic circulatory arrest; recombinant activated factor VII; 26.1; FFP; rFVIIa; 41.1; ICU; intensive care unit; DHCA; packed red blood cell; Treatment; Surgery; Use; Anesthesia; Aorta; Intraoperative; Circulatory system; Cardiology; Complexes; Coagulation factor; Factor VII
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2012.01.004

Objective Postoperative bleeding is a major cause of morbidity and mortality after complex aortic surgery. Intraoperative coagulopathy is a well-known culprit in this process. Recombinant activated factor VII is increasingly used for the postoperative management of such bleeding. We report our experience with the intraoperative use of this agent. Methods We performed a propensity-matched analysis on 376 retrospectively identified patients who underwent aortic root, arch, or ascending aortic replacement surgeries from 1999 to 2010. We matched a total of 58 patients: recombinant activated factor VII–treated group (n = 29) and nonrecombinant activated factor VII–treated group (n = 29). We compared the matched patients on re-exploration, mortality, bleeding-related events, use of blood and blood products, length of intensive care unit stay, duration of hospitalization, and thrombotic complications. Results Propensity-matched patients had similar preoperative and intraoperative characteristics. The mean dose of recombinant activated factor VII group was 23 ± 12 μg/kg. We found significantly lower rates of surgical re-exploration ( P  = .004), fewer prolonged intubations ( P  = .004), less total chest tube output ( P  = .01), and fewer units of packed red blood cells ( P  = .01) and fresh-frozen plasma ( P  = .04) transfused postoperatively in the recombinant activated factor VII group. There was no significant difference in mortality ( P  = 1), duration of intensive care unit stay ( P  = .44) or hospital stay ( P  = .32), or thrombotic complications between the groups ( P  = .5). Conclusions We recommend the intraoperative administration of low-dose recombinant activated factor VII but limited to the management of persistent, nonsurgical, mediastinal bleeding in aortic surgery. Further prospective randomized studies and larger cohorts are needed to verify these findings.