Brian A. Bruckner

Topical haemostatic agents are useful adjuncts for the overall approach to haemostasis during mechanical support and cardiac transplant surgical procedures. Increasing numbers of cardiac surgical patients are presenting with pharmacologically induced impairment of the clotting cascade. Additionally, there continues to be an increase in the numbers of ventricular assist device implantations worldwide and these patients have haemostasis challenges both at the time of implantation and at subsequent transplantation. Patients undergoing assist device placement or cardiac transplantation usually have severe, refractory heart failure and varying degrees of multi-organ dysfunction, which make them susceptible to bleeding during the surgical procedure. Despite routine blood conservation measures and the use of intravenous agents, local surgical field haemostasis still remains a challenge. Topical agents are increasingly used in cardiac surgical procedures, especially in assist device or transplant cases. Herein, we report our institutional approach to topical haemostasis in a high-risk group of patients undergoing assist device or cardiac transplant. AristaAH®, a novel polysaccharide topical haemostat, provides effective and safe control of challenging bleeding situations.

We report the case of a 38-year-old woman who underwent cardiac sarcoma resection and presented later with spontaneous left ventricular free-wall rupture. The original tumor resection required autotransplantation and a transmitral approach, including partial resection of the inner left ventricular wall. Although the patient did well postoperatively, 3 weeks later she developed a large pericardial effusion with tamponade. Intraoperatively, a portion of the left ventricular free wall ruptured and required repair with a Dacron patch. The patient recovered and was discharged from the hospital 3 weeks later. To our knowledge, this is the 1st reported case of spontaneous ventricular rupture after the resection of a cardiac tumor.