Successful pediatric heart transplantation with bivalirudin use in a cyanotic single ventricle patient with an intracorporeal continuous flow ventricular assist device and heparin-induced thrombocytopenia

We describe a case of profound coagulopathy during orthotopic heart transplantation in a cyanotic single ventricle pediatric patient with an intracorporeal continuous flow ventricular assist device performed on bivalirudin for heparin-induced thrombocytopenia. This was successfully managed with central veno-arterial extracorporeal membrane oxygenation and hemofiltration as an adjunct to treat bivalirudin-induced coagulopathy due to lack of a reversal agent for bivalirudin.