Associate Professor Emory University/Children's Health ATLANTA, Georgia, United States
Abstract:
Introduction: Children undergoing cardiac surgery have increased rates of thrombosis (9-27%) compared to other hospitalized children (1-3). In a retrospective study of infants undergoing cardiac surgery, we found that age < 30 days was associated with increased thrombosis rate (29.5%) (4). As thrombotic complications are associated with increased morbidity and mortality, we hypothesized that a prophylactic heparin protocol could reduce the incidence of perioperative thrombosis in neonates undergoing cardiac surgery.
Methods: After IRB approval, we used our institutional Society of Thoracic Surgery (STS) database to identify neonates (age < 30 days) who underwent cardiac surgery between August 1, 2019 and July 31st, 2021. Demographics, perioperative factors, outcomes, including thrombosis were collected. We identified all surgical patients who experienced a thrombotic event during the same hospital stay and confirmed the diagnosis with positive imaging studies. For patients undergoing multiple procedures during the hospital length of stay, the STS index procedure was used as the primary surgical event. Our primary outcome was the difference in thrombosis rate between the pre-heparin protocol (PreHP) and post-heparin protocol (Post-HP) cohorts. Secondary outcomes included risk factors for thrombosis, hospital and ICU length of stay (LOS), and adverse events (AE).
Results: Our populations consisted of 280 neonates (128= preHP; 152 =postHP). The two cohorts were similar except for longer anesthesia times for the postHP group. The overall incidence of thrombosis was 25% (30% and 19.7% in PreHP and PostHP cohorts, respectively). Risk factors associated with thrombosis are listed in Table 1. Thrombosis was associated with increased death, complications, ICU and hospital length of stay (LOS) (Table 2). A multivariable logistic regression adjusting for statistically significant risk factors in the univariate analysis demonstrated that patients in the preHP were 1.67 times more likely to develop thrombosis than in the PostHP (Table 3).
Conclusion: Prematurity, STAT scores, and multiple surgeries are associated with thrombosis. After adjusting for risk factors, prophylactic heparin infusions in neonates with central lines reduce thrombosis rate for neonates undergoing cardiac surgery.
References: 1. Manlhiot C Circulation 2011 3. Faraoni D JCVA 2017 4. Guo et al, ASA Oral Abstract Presentation, 2021
