Thrombosis common complication in child heart surgery patients
The incidence of thrombosis in pediatric cardiac surgery patients has been previously underestimated, according to research published the journal Circulation.
Thrombosis in children undergoing cardiac procedures is clinically important but rare, so has not attracted much research focus in the past, and has been examined alongside cases in children with other conditions.
This study considered all 1361 patients under 18 years old with congenital heart disease who underwent 1542 cardiac surgeries between September 2004 and December 2007 at The Hospital for Sick Children in Toronto, Ontario, Canada.
Overall, 444 thrombi occurred in 171 patients. Extrathoracic venous thrombosis in the upper and lower limbs was the most prevalent type. However, the researchers think this might be an underestimation because there was no consistent protocol for detecting thrombosis during the study period, so only clinically evident thrombosis is considered.
Brian McCrindle (The Hospital for Sick Children) and colleagues identified a number of risk factors associated with increased odds of thrombosis. These were age, baseline oxygen saturation, previous thrombosis, heart transplantation, use of deep hypothermic circulatory arrest, longer cumulative time with central lines, and postoperative use of extracorporeal support.
Forty-seven of the 171 patients experienced serious complications, either due to the location of the thrombus (especially cardiac arterial thromboses), symptomatic thrombi, or thrombus occlusion. These complications included cardiopulmonary arrest, cardioembolic arterial ischemic stroke and death associated with thrombosis.
Long-term assessment was possible for 129 of the patients with thrombosis; 197 of their 316 thrombi resolved. Patients with thrombosis also stayed, on average, 10 days longer in intensive case and 15 days longer in hospital than the other pediatric cardiac patients.
"This study establishes thrombosis in the context of pediatric cardiac surgery as an important clinical problem and will, we hope, form the basis of future research aimed at better prevention, diagnosis, and treatment of those complications" conclude McCrindle and his team.
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By Chloe McIvor