Aortic dissection and hypothermic arrest in a Jehovah’s Witness patient: a case for recombinant factor VIIa?

Purpose: To present a case of survival of a cognitively intact Jehovah’s Witness patient with an aortic dissectionwho underwent hypothermic arrest. Recombinant factor VIIa, but no blood productswere administered. Clinical features: An 83-yr-old female with an acute type A aortic dissectionunderwent emergent surgical repair. Proximal extension of the dissection necessitated prolonged cardiopulmonary bypass (CPB) and hypothermic circulatory arrest. Despite this, perioperative hemostatis was adequate. Recombinant factor VIIa90 µg·kg –1 iv was administered post-CPB. The patient had an uneventful postoperative course, and was discharged home neurologically intact. Conclusions: Patients who conscientiously object to the transfusion of blood productsmay present a considerable anesthetic challenge, especially those at risk from coagulopathyassociated with CPB and hypothermic circulatory arrest. Recombinant factor VIIamay play a role in hemostasis management of these individuals, however, well-designed randomized controlled trials need to be undertaken to establish the efficacy and risks related to this potential indication.