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Children undergoing cardiac surgery for complex cardiac defects show imbalance between pro- and anti-thrombotic

Ruth Heying1, Wim van Oeveren, Stefanie Wilhelm

  • 1Department of Pediatric Cardiology, University Hospital, RWTH-Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany. heying@uni-duesseldorf.de

Critical Care (London, England)
|November 28, 2006
PubMed

Insights

Pediatric cardiac surgery temporarily disrupts the balance of blood clotting factors, increasing prothrombotic activity. These changes, particularly after total cavopulmonary connection, can pose risks for thromboembolic complications in children.

Area of Science:

  • Pediatric Cardiology
  • Hemostasis and Thrombosis
  • Cardiovascular Surgery

Background:

  • Cardiac surgery using cardiopulmonary bypass (CPB) can activate inflammatory pathways, leading to prothrombotic states and potential postoperative bleeding or clotting issues.
  • Children undergoing complex cardiac defect repair are at risk for haemostatic disorders due to CPB-induced inflammation.

Purpose of the Study:

  • To investigate the impact of cardiac surgery on prothrombotic and anti-thrombotic activity in children with complex cardiac defects.
  • To compare these effects between univentricular palliation (total cavopulmonary connection) and biventricular repair procedures.

Main Methods:

  • Studied 18 children (3-163 months) undergoing either total cavopulmonary connection (TCPC) or biventricular repair.
  • Measured plasma levels of prothrombin fragment 1+2 (F1+2), thromboxane B2 (TxB2), monocyte chemoattractant protein-1 (MCP-1), and tissue factor pathway inhibitor (TFPI) pre-, during-, and post-surgery.

Main Results:

  • Cardiac surgery caused a transient increase in F1+2, TxB2, MCP-1, and TFPI, with peak prothrombotic markers at CPB's end.
  • Lower esophageal temperatures during CPB correlated with higher F1+2 levels post-surgery.
  • Postoperative TFPI was lower and TxB2 higher in TCPC patients versus biventricular repair patients; no thromboembolic events occurred.

Conclusions:

  • Children with complex cardiac defects exhibit a temporary pro- and anti-thrombotic imbalance after surgery, potentially leading to complications.
  • The imbalance is more pronounced after TCPC compared to biventricular repair, possibly linked to low antithrombin III levels.
Abstract

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