Perioperative management of hemophilia A during coronary artery bypass grafting with patent foramen ovale repair

TL;DR

A 68-year-old man with mild hemophilia A successfully underwent heart surgery with a Factor VIII infusion strategy that prevented excessive bleeding.

Contribution

The paper presents a successful case of managing hemophilia A during complex cardiac surgery using a recombinant Factor VIII regimen.

Findings

A recombinant Factor VIII bolus and infusion prevented increased bleeding during surgery.

The patient did not require postoperative blood transfusions.

Postoperative complications included sternal wound dehiscence but were managed without additional bleeding issues.

Abstract

Factor VIII deficiency, also known as hemophilia A, is the most common inherited bleeding disorder. Deficiency of Factor VIII results in dysfunction of platelet aggregation due to decreased activation of Factor X to Xa. We present the case of a 68-year-old male with mild hemophilia A (Factor VIII activity, 16%) who underwent a three-vessel coronary artery bypass graft and patent foramen ovale repair, with no increased bleeding utilizing a recombinant Factor VIII (kogenate) preoperative bolus and continuous infusion. His postoperative course was complicated by a sternal wound dehiscence requiring washout, sternal wire removal and omental flap coverage on postoperative Day 21. However, he required no postoperative blood transfusions.