Off-pump technique and replacement therapy for coronary artery bypass surgery in a patient with hemophilia B

Cardiovascular disease in hereditary haemophilia: The challenges of longevity

“…With immediate and plentiful availability of clotting factor concentrates, a multidisciplinary haemophilia team and an onsite specialist coagulation laboratory, any surgery including cardiac surgery, can be carried out safely in PWH 59 . Despite this, less invasive procedures of equal efficacy are preferred such as the use of PCI instead of CABG, transcatheter correction of septal defects and valve implantations and use of off cardiopulmonary bypass (CBP) procedures 60‐62 …”

“…The number of these procedures carried out has reduced significantly in recent years. Off‐CPB procedures are possible and should be used in preference, if available 62 . The outcome of CABG in PWH has been reported to be good in the papers published to date.…”

Robotic mitral valve repair in a type B hemophiliac

“…The use of antiplatelet agents, chemical DVT prophylaxis, and systemic anticoagulation (in the case of valve repair or replacement) is also inconsistent, though all have been reported with good outcomes in select patients. 3,4,6,[8][9][10]12 4 | CONCLUSION This case demonstrates that robotic mitral valve repair can be safely performed in a patient with hemophilia. A multidisciplinary approach involving the hematologist and surgeon in the pre-, peri-, and postoperative periods is essential for successfully addressing any potential bleeding complications.…”

“…Reports are widely varied regarding whether recombinant factors should be bolused or given as continuous infusions to achieve the desired level. The use of antiplatelet agents, chemical DVT prophylaxis, and systemic anticoagulation (in the case of valve repair or replacement) is also inconsistent, though all have been reported with good outcomes in select patients 3,4,6,8‐10,12 …”

“…Several authors have described cardiac surgery in patients with hemophilia A and B, including on-pump coronary artery bypass grafting (CABG), [3][4][5] off-pump CABG, 6 aortic valve replacement (AVR), 3,[7][8][9][10] and mitral valve repair. 3,11,12 In general, these patients had good survival outcomes, though many developed bleeding complications.…”