Activated thrombelastogram in neonates and infants with complex congenital heart disease in comparison with healthy children

Background. The goal of the study was to determine activated thrombelastographic (TEG (R)) parameters with the rotational TEG (R) (ROTEG or ROTEM) device (Pentapharm GmbH, Munich, Germany) in neonates and infants < 1 yr with complex congenital heart disease (CCHD) and to compare them with those of healthy children. Methods. A total of 59 children were included: Group I (Gr I) 24 children, ASA I, scheduled for minor surgery; and Group II (Gr II) 35 children with CCHD, ASA III-IV, scheduled for cardiac surgery. Each group was subdivided into four age groups. Blood samples were obtained before the surgical procedure. Results. Statistically significant differences (two-way anova analysis) between Gr I and Gr II [mean (sd); P-value] were found in INTEG-CT [Gr I 175(19), Gr II 271(162); P=0.049], EXTEG-MCF [Gr I 63(8), Gr II 56(8); P=0.013], EXTEG-MCE [Gr I 186(65), Gr II 137(41); P=0.003], FIBTEG-MCF [Gr I 24(7), Gr II 19(5); P=0.012], FIBTEG-MCE [Gr I 32(13), Gr II 24(8); P=0.012] and EXTEG-MCE-FIBTEG-MCE [Gr I 155(55), Gr II 113(37); P=0.003]. Clotting time via contact activation was prolonged in Gr II and varied widely, mainly in the age group 0-1 month and to a lesser extent in 1-3 months, and maximum clot firmness was reduced in the same age groups. In comparison with Gr II, the healthy children showed relatively homogenous TEG values with a tendency to hypercoagulability; the maximum was found in age group 1-3 months, decreasing towards adult values in the course of the first year of life. Conclusions. These preliminary TEG results indicate that the coagulation-fibrinolytic system in CCHD patients < 1 yr is functionally intact and balanced but at a lower level than in healthy children. This could be interpreted as a reduction in the haemostatic potential with less reserve.