Pediatric Cardiology

Biography

Biography: Vladimiro L. Vida

Abstract

Background: to evaluate the preoperative coagulation pattern and the postoperative blood product requirement (PBPR) in children with congenital heart disease (CHD), focusing on cyanotic patients (oxygen saturation, SATO<85%). Methods: From January to August 2014 standard coagulation tests and ROTEM® assays were performed on paediatric patients (16 years) who underwent surgery for CHD.
Results: Eighty-one consecutive patients were included; 21 (26%) patients were cyanotic and 60 (74%) non-cyanotic. Mean age at surgery was 7.9 months (range 1 day-16 years). Cyanotic patients had a significantly higher haematocrit (p<0.001), a reduced prothrombin activity (PT %, p=0.01) level and lower platelets count (p=0.02) than non cyanotic patients. An inverse linear association was found between Clot Formation Time (CFT) and SATO2 (INTEM, p=0.001 and EXTEM, p<0.0001), and also between CFT and preoperative platelets count (INTEM, p=0.0005 and EXTEM, p=0.0003). A direct linear association was found between Maximum Clot Firmness (MCF) and patients’ SATO2 (INTEM, p=0.04 and EXTEM, p=0.05). Preoperative cyanosis was also associated to a lower median MCF in FIBTEM (p=0.02). Cyanotic patients required more frequently postoperative transfusions of fresh frozen plasma (FFP, p=0.01) and fibrinogen (p=0.0001). Pre-operative lower PT and platelets count were associated to an increased post-operative fibrinogen administration p=0.02 and p=0.0001, respectively), as well as a longer CFT (INTEM, p=0.03 and EXTEM, p=0.007), and a reduced MCF (EXTEM, p=0.01 and FIBTEM, p=0.002).
Conclusions: ROTEM® parameters add important specific preoperative information to classic coagulation parameters in patients with CHD. Cyanotic patients presented with preoperative coagulation anomalies significantly requiring higher postoperative blood product supplementation.