Cardiac transplantation in a patient with protein S deficiency

Cardiac transplantation was successfully performed in a patient with end-st age ischemic cardiomyopathy and hereditary protein S deficiency who had und ergone two previous coronary artery bypass graft procedures. Routine intrao perative heparinization and reversal with protamine was undertaken, and the antifibrinolytic agent aprotinin was infused throughout the procedure with out perioperative hemorrhage or thrombosis. Systemic anticoagulation with i ntravenous heparin was resumed on postoperative day 2 and the patient was t hen converted to Lovenex as outpatient anticoagulation to facilitate routin e surveillance endomyocardial biopsies. (Ann Thorac Surg 1999;68:1078-80) ( C) 1999 by The Society of Thoracic Surgeons.