Successful pediatric heart transplantation with bivalirudin use in a cyanotic single ventricle patient with an intracorporeal continuous flow ventricular assist device and heparin-induced thrombocytopenia

TL;DR

A child with a heart condition successfully underwent heart transplant using bivalirudin, managed with special support due to blood clotting issues.

Contribution

Demonstrates successful management of bivalirudin-induced coagulopathy during pediatric heart transplant.

Findings

Bivalirudin was used safely in a patient with heparin-induced thrombocytopenia during heart transplant.

Coagulopathy was managed using extracorporeal membrane oxygenation and hemofiltration.

Successful outcome achieved despite complex coagulation challenges.

Abstract

We describe a case of profound coagulopathy during orthotopic heart transplantation in a cyanotic single ventricle pediatric patient with an intracorporeal continuous flow ventricular assist device performed on bivalirudin for heparin-induced thrombocytopenia. This was successfully managed with central veno-arterial extracorporeal membrane oxygenation and hemofiltration as an adjunct to treat bivalirudin-induced coagulopathy due to lack of a reversal agent for bivalirudin.

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