The addition of Tirofiban infusion to heparin for intraoperative heparin resistance associated with Marfan Syndrome

Marfan syndrome classically presents with aortic root aneurysms. Aortic ectasia causes diverse blood flow alterations, influencing the behavior of coagulation factors and platelet activity. Heparin resistance has also been reported associated Syndrome in a small number patients, probably due to antithrombin III (ATIII) deficiency or various mutations. The ascending aorta valve are replaced prosthetic material during Bentall- de Bonno procedures. Resistance anticoagulation extracorporeal circulation, represents significant challenge for both anesthesiologists surgical team. heparin was observed patient undergoing Bentall procedure. ATIII concentrate not available, ACT did increase despite high doses heparin. An alternate approach used successfully.