Our Summary

This research paper discusses a rare occurrence: patients with hemophilia A and B undergoing coronary artery bypass surgery. Hemophilia is a disorder that impairs the body’s ability to make blood clots, which can lead to excessive bleeding. During and after the surgery, patients usually need high doses of a specific treatment, known as factor concentrate, to ensure their blood can clot properly. This treatment can be given all at once or continuously infused. The paper also notes that using a drug called heparin during the heart-lung machine process is safe, and a technique that recycles the patient’s own blood during surgery can lessen the need for blood transfusions.

FAQs

  1. What treatment is usually required for patients with Hemophilia A and B before and after coronary artery bypass surgery?
  2. Is heparinization during cardiopulmonary bypass safe for patients with hemophilia?
  3. How does the use of intra-operative blood salvage techniques affect the need for transfusions during coronary artery bypass surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about heart bypass surgery is to carefully follow your medication regimen, especially if you have a bleeding disorder like hemophilia. It is important to maintain high levels of replacement therapy with factor concentrate before and after the surgery to ensure proper coagulation. Additionally, discuss with your healthcare team about using heparin during the procedure and utilizing blood salvage techniques to minimize the need for transfusions.

Suitable For

Patients with severe coronary artery disease, including those with multiple blockages in their coronary arteries, are typically recommended for heart bypass surgery. Additionally, patients who have not had success with other treatments such as medication or angioplasty may also be candidates for bypass surgery. Patients with certain risk factors such as diabetes, smoking, or a family history of heart disease may also be recommended for bypass surgery. Ultimately, the decision to undergo bypass surgery is made on a case-by-case basis by the patient’s healthcare team.

Timeline

Before heart bypass surgery:

  • Patient undergoes diagnostic tests such as coronary angiography to determine the extent of blockages in the arteries
  • Patient may need to undergo pre-operative interventions such as medication management or lifestyle changes to optimize their health before surgery
  • Patient may receive factor concentrate therapy to ensure adequate clotting factors are present for surgery

After heart bypass surgery:

  • Patient is closely monitored in the intensive care unit (ICU) for the first few days post-surgery
  • Patient may receive blood transfusions if needed to replace blood loss during surgery
  • Patient undergoes cardiac rehabilitation to regain strength and function after surgery
  • Patient may need to continue taking medications to manage heart health and prevent future blockages

Overall, the patient’s experience before and after heart bypass surgery involves a combination of diagnostic tests, medical interventions, intensive care, and rehabilitation to ensure successful recovery and long-term heart health.

What to Ask Your Doctor

  1. What specific preparations will I need to make before the surgery?
  2. How long will the surgery take, and what can I expect during the recovery process?
  3. What are the potential risks and complications associated with heart bypass surgery?
  4. Will I need to continue taking any medications after the surgery, and if so, for how long?
  5. How soon can I expect to return to normal activities and exercise after the surgery?
  6. Will I need any follow-up appointments or tests to monitor my heart health after the surgery?
  7. How will my hemophilia condition affect the surgery and my recovery process?
  8. Will I need to receive factor concentrate therapy before and after the surgery, and if so, how will it be administered?
  9. Are there any specific precautions or considerations I should be aware of during the recovery process due to my hemophilia?
  10. How can I best manage my hemophilia condition in conjunction with my heart health moving forward?

Reference

Authors: Kanellopoulou T, Nomikou E. Journal: J Card Surg. 2018 Feb;33(2):76-82. doi: 10.1111/jocs.13530. Epub 2018 Feb 13. PMID: 29439283