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PEDIATRIC ANESTHESIA

The Hemostatic History of a 15-Month-Old Child Implanted with a Berlin Heart Left Ventricular Assist Device

Brad L. Steenwyk, MD^*, James K. Kirklin, MD, William Q. Gurley, MD^*, and Vance G. Nielsen, MD^*

From the Departments of *Anesthesiology and Surgery, The University of Alabama at Birmingham, Birmingham, Alabama.

Address correspondence and reprint requests to Vance G. Nielsen, MD, Department of Anesthesiology, The University of Alabama at Birmingham, Basic Medical Research Building II, Room 210, 901 19th St. South, Birmingham, AL 35294-2172. Address e-mail to vnielsen{at}uab.edu.

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.

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