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Coronary artery bypass graft in a patient with Von Willebrand disease type 1
, 1, 2, 2, 3, 4, 5, 2
Affiliations- Student Scientific Association of Adult Cardiac Surgery; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Katowice, Poland
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases in Zabrze, Zabrze, Poland
- Department of Haematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Katowice, Poland
- Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
- Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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Abstract
Von Willebrand disease (VWD), is the most common hereditary bleeding disorder (HBD) and affects approximately 1–2% of the population. Type 1 accounts for 70–80% of all cases and involves partially reduced levels of functional VWF. It is usually manifested by mild to moderate mucocutaneous bleeding. A 63-yearold patient with multivessel coronary artery disease and diagnosed with Von Willebrand’s disease type 1 after a previous NSTEMI infarction (10 days earlier) was admitted to the cardiac surgery department for a planned CABG procedure. The coagulation factor values on admission to the ward were successively (VIII 15%; VWF: Ag 12%). Coronary angiography revealed MV CAD. The patient was consulted with the HEART Team. The decision was made to qualify the patient for CABG using the OPCAB technique. A detailed plan for securing the haemostasis was established. Haemate P 500/1200 and 1000/2400, a lyophilized concentrate of humans VIII and von Willebrand Factors, were secured. During surgery, LITA- LAD and Ao- RCA bridges were performed using Medtronic Starfish® Heart Positioners. In the post-operation period, no complications were noted. Plasma levels of VIII and VW factors were measured daily and antihemorrhagic prophylaxis was given accordingly to measured values. The patient was discharged on the eighth day after surgery in good condition, with the haematological recommendations. Currently, there are no guidelines for the management of patients with Von Willebrand’s disease undergoing cardiac surgery. Incorrectly conducted pharmacotherapy may result in an elevated level of VW factor and additional exposure to the occurrence of acute coronary syndromes and heart attacks.
Abstract
Von Willebrand disease (VWD), is the most common hereditary bleeding disorder (HBD) and affects approximately 1–2% of the population. Type 1 accounts for 70–80% of all cases and involves partially reduced levels of functional VWF. It is usually manifested by mild to moderate mucocutaneous bleeding. A 63-yearold patient with multivessel coronary artery disease and diagnosed with Von Willebrand’s disease type 1 after a previous NSTEMI infarction (10 days earlier) was admitted to the cardiac surgery department for a planned CABG procedure. The coagulation factor values on admission to the ward were successively (VIII 15%; VWF: Ag 12%). Coronary angiography revealed MV CAD. The patient was consulted with the HEART Team. The decision was made to qualify the patient for CABG using the OPCAB technique. A detailed plan for securing the haemostasis was established. Haemate P 500/1200 and 1000/2400, a lyophilized concentrate of humans VIII and von Willebrand Factors, were secured. During surgery, LITA- LAD and Ao- RCA bridges were performed using Medtronic Starfish® Heart Positioners. In the post-operation period, no complications were noted. Plasma levels of VIII and VW factors were measured daily and antihemorrhagic prophylaxis was given accordingly to measured values. The patient was discharged on the eighth day after surgery in good condition, with the haematological recommendations. Currently, there are no guidelines for the management of patients with Von Willebrand’s disease undergoing cardiac surgery. Incorrectly conducted pharmacotherapy may result in an elevated level of VW factor and additional exposure to the occurrence of acute coronary syndromes and heart attacks.
Keywords
atherosclerosis, CABG, haemorrhagic diathesis, cardiac surgery, haematology
About this articleTitle
Coronary artery bypass graft in a patient with Von Willebrand disease type 1
Journal
Issue
Article type
Case report
Pages
164-167
Published online
2023-06-22
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1257
Article views/downloads
399
DOI
Bibliographic record
Medical Research Journal 2023;8(2):164-167.
Keywords
atherosclerosis
CABG
haemorrhagic diathesis
cardiac surgery
haematology
Authors
Sebastian Krych
Katarzyna Krzyżak
Tomasz Styn
Witold Bratkowski
Michał Jamrozik
Małgorzata Knapik
Małgorzata Jekiełek
Tomasz Hrapkowicz
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- Hassan SA, Amer S, Qureshi W, et al. Treating symptomatic coronary artery disease in patients with Von Willebrand disease. Hematol Oncol Stem Cell Ther. 2013; 6(3-4): 101–104.
- Wippermann J, Albes JM, Hartrumpf M, et al. Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system. Eur J Cardiothorac Surg. 2005; 28(1): 127–132.