Risk, Clinical Features, and Outcomes of Thrombosis Associated With Pediatric Cardiac Surgery

被引：152

作者：

Manlhiot, Cedric ^{[1
,2
,3
]}

Menjak, Ines B. ^{[1
,2
,3
]}

Brandao, Leonardo R. ^{[4
]}

Gruenwald, Colleen E. ^{[1
,2
,3
]}

Schwartz, Steven M. ^{[1
,2
,3
]}

Ben Sivarajan, V. ^{[1
,2
,3
]}

Yoon, Hyaemin ^{[1
,2
,3
]}

Maratta, Robert ^{[1
,2
,3
]}

Carew, Caitlin L. ^{[1
,2
,3
]}

McMullen, Janet A. ^{[1
,2
,3
]}

Clarizia, Nadia A. ^{[1
,2
,3
]}

Holtby, Helen M. ^{[1
,2
,3
]}

Williams, Suzan ^{[4
]}

Caldarone, Christopher A. ^{[1
,2
,3
]}

Van Arsdell, Glen S. ^{[1
,2
,3
]}

Chan, Anthony K. ^{[5
]}

McCrindle, Brian W. ^{[1
,2
,3
]}

机构：

[1] Univ Toronto, Hosp Sick Children, Labatt Family Heart Ctr, Dept Pediat, Toronto, ON M5G 1X8, Canada

[2] Univ Toronto, Hosp Sick Children, Labatt Family Heart Ctr, Dept Surg, Toronto, ON M5G 1X8, Canada

[3] Univ Toronto, Hosp Sick Children, Labatt Family Heart Ctr, Dept Crit Care Med, Toronto, ON M5G 1X8, Canada

[4] Univ Toronto, Hosp Sick Children, Dept Pediat, Div Hematol Oncol, Toronto, ON M5G 1X8, Canada

[5] McMaster Univ, McMaster Childrens Med Ctr, Div Pediat Hematol Oncol, Hamilton, ON, Canada

来源：

CIRCULATION | 2011年 / 124卷 / 14期

关键词：

heart defects; congenital; morbidity; pediatrics; surgery; thrombosis; CONGENITAL HEART-DISEASE; DEEP VENOUS THROMBOSIS; CARDIOPULMONARY BYPASS; POSTTHROMBOTIC SYNDROME; INFLAMMATORY RESPONSE; PULMONARY-EMBOLISM; CHILDREN; THROMBOEMBOLISM; HEPARIN; ARTERIAL;

D O I：

10.1161/CIRCULATIONAHA.110.006304

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background-Thrombosis, usually considered a serious but rare complication of pediatric cardiac surgery, has not been a major clinical and/or research focus in the past. Methods and Results-We noted 444 thrombi (66% occlusive, 60% symptomatic) in 171 of 1542 surgeries (11%). Factors associated with increased odds of thrombosis were age <31 days (odds ratio [OR], 2.0; P=0.002), baseline oxygen saturation <85% (OR, 2.0; P=0.001), previous thrombosis (OR, 2.6; P=0.001), heart transplantation (OR, 4.1; P<0.001), use of deep hypothermic circulatory arrest (OR, 1.9 P=0.01), longer cumulative time with central lines (OR, 1.2 per 5-day equivalent; P<0.001), and postoperative use of extracorporeal support (OR, 5.2; P<0.001). Serious complications of thrombosis occurred with 64 of 444 thrombi (14%) in 47 of 171 patients (28%), and were associated with thrombus location (intrathoracic, 45%; extrathoracic arterial, 19%; extrathoracic venous, 8%; P<0.001), symptomatic thrombi (OR, 8.0; P=0.02), and partially/fully occluding thrombi (OR, 14.3; P=0.001); indwelling access line in vessel (versus no access line) was associated with lower risk of serious complications (OR, 0.4; P=0.05). Thrombosis was associated with longer intensive care unit (+10.0 days; P<0.001) and hospital stay (+15.2 days; P<0.001); higher odds of cardiac arrest (OR, 4.9; P<0.001), catheter reintervention (OR, 3.3; P=0.002), and reoperation (OR, 2.5; P=0.003); and increased mortality (OR, 5.1; P<0.001). Long-term outcome assessment was possible for 316 thrombi in 129 patients. Of those, 197 (62%) had resolved at the last follow-up. Factors associated with increased odds of thrombus resolution were location (intrathoracic, 75%; extrathoracic arterial, 89%; extrathoracic venous, 60%; P=0.001), nonocclusive thrombi (OR, 2.2; P=0.01), older age at surgery (OR, 1.2 per year; P=0.04), higher white blood cell count (OR, 1.1/10(9) cells per 1 mL; P=0.002), and lower fibrinogen (OR, 1.4/g/L; P=0.02) after surgery. Conclusions-Thrombosis affects a high proportion of children undergoing cardiac surgery and is associated with suboptimal outcomes. Increased awareness and effective prevention and detection strategies are needed. (Circulation. 2011;124:1511-1519.)

引用

页码：1511 / U64

页数：13

共 42 条

[31] Developmental haemostasis - Impact for clinical haemostasis laboratories [J].