Off-Pump Coronary Artery Bypass Grafting in a Patient With Hemophilia A

Abstract

Hemophilia is a bleeding disorder caused by a congenital deficiency of coagulation factors VIII or IX. Because an increasing number of patients with hemophilia are achieving a near-normal lifespan, some of them develop age-related cardiovascular disease. Herein, we report successful off-pump coronary artery bypass grafting in a patient with hemophilia A. A 55-year-old man with hemophilia A developed chest pain and cardiac catheterization revealed severe triple vessel disease. Before surgery, a bolus of 100 IU/kg of recombinant factor VIII (rFVIII) was administered to maintain factor VIII activity around 100%. Coronary artery bypass grafting was then performed under heparinization without cardiopulmonary bypass or blood transfusion. Subsequently, continuous infusion of rFVIII was administered until the 10th postoperative day. No bleeding complications occurred. Coronary artery computed tomography revealed patency of all bypass grafts on the 7th postoperative day. The postoperative course was uneventful and the patient was discharged on the 13th postoperative day.