Blutungen nach herzchirurgischen Operationen

Zusammenfassung

Herzchirurgische Operationen sind mit dem Risiko verbunden, einen relevanten Blutverlust zu erleiden und eine Transfusion von Blutprodukten zu erhalten. Neben dem Blutverlust treten internationalen Studien zufolge schwere Blutungen, die eine Reoperation zur Blutstillung erfordern, bei 3-5% der Patienten auf. Die Morbidität und Mortalität ist signifikant erhöht, so dass eine effektive und sichere hämostatische Therapie die Prognose entscheidend verbessern kann.

Rekombinanter aktivierter Faktor VII ist für die Therapie von Patienten mit Hemmkörper-Hämophilie sowie Thrombasthenie Glanzmann und Faktor-VII-Mangel zugelassen. In den vergangenen Jahren häufen sich die Publikationen, die über eine erfolgreiche und sichere Stillung von Blutungen nach herzchirurgischen Operationen berichten, die einer konventionellen Therapie gegenüber refraktär waren. Dieses Review stellt die pathophysiologischen Veränderungen des Gerinnungssystems, die der Anschluss an die Herz- Lungen-Maschine induziert und die für die Erklärung des erhöhten Blutungsrisikos herzchirurgischer Patienten herangezogen werden, dar. Die publizierten Erfahrungen mit rFVIIa in der Kinder- und Erwachsenen-Herzchirurgie werden dargestellt und hinsichtlich der Effektivität und Sicherheit kritisch diskutiert.

Summary

Cardiac surgery carries a remarkable risk of blood loss requiring transfusion of blood products. Moreover, severe bleeding necessitating reoperation occurs in 3-5% of patients according to international studies. These patients face a significantly higher morbidity and mortality. This underscores the need for a safe and effective haemostatic therapy, which may significantly improve the outcome. Recombinant activated factor VII is approved for haemophiliacs with inhibitors and patients with thrombasthenia Glanzmann and factor VII deficiency. In the preceeding years a series of articles has been published reporting the successful and safe therapy of refractory bleeding after cardiac surgery. This review focuses at presenting the pathophysiological alterations of the haemostatic system related to the cardiopulmonary bypass. These alterations are thought to explain the high risk of bleeding after cardiopulmonary bypass. Furthermore, the use of rFVIIa in paediatric and adult cardiac surgery is reviewed and critically discussed.

Schlüsselwörter

Herzchirurgie - rFVIIa - Herz-Lungen-Maschine - Blutung

Keywords

Cardiac surgery - rFVIIa - cardiopulmonary bypass - bleeding

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