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Morphology-Based Risk Analysis of Catheter-related Thrombus After Pediatric Cardiac Surgery
Hisataka Nozawa1, Tomomi Fujimura1, Tomosato Yamagata1
1Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan.
Insights
The catheter occupying the internal jugular vein area (C/V ratio) is the main risk factor for central venous catheter-related thrombus (CVCRT) in children undergoing cardiac surgery. This finding aids in preventing adverse events from thrombi.
Area of Science:
- Pediatric Cardiology
- Vascular Surgery
- Thrombosis Research
Background:
- Central venous catheter-related thrombus (CVCRT) is a concern in pediatric cardiac surgery, but its risks are debated.
- Understanding CVCRT development is crucial for preventing associated adverse events.
Purpose of the Study:
- To analyze the risk factors of CVCRT in children undergoing cardiac surgery.
- To evaluate the morphometric features and severity of CVCRT.
Main Methods:
- Included patients <15 years old undergoing internal jugular vein catheterization for cardiac surgery (excluding ECMO).
- Collected clinical data and ultrasound images, calculating the catheter-to-vein area ratio (C/V ratio).
- Used logistic regression to identify risk factors based on thrombus severity.
Main Results:
- CVCRT developed in 38 of 47 patients, with 5 morphologic types identified.
- Severe CVCRT cases (sheath-like thrombus) were associated with younger age and higher C/V ratios.
- The C/V ratio was the sole significant risk factor for CVCRT (OR, 1.120; P = .036).
Conclusions:
- Thrombus evaluation and morphologic classification are clinically important for assessing CVCRT risk in pediatric cardiac patients.
- The C/V ratio is a key indicator for predicting CVCRT development.
Background:
Understanding the development of central venous catheter-related thrombus (CVCRT) is vital for the prevention of adverse events caused by thrombi after cardiac surgery in children. However, the risks associated with CVCRT remain controversial. This study analyzed the risk factors of CVCRT based on a detailed evaluation of its morphometric features and severity.
Methods:
Patients aged <15 years who underwent catheter insertion into the internal jugular vein for cardiac surgery were included, and those receiving extracorporeal membrane oxygenation were excluded. The clinical data of the eligible patients, including the ultrasound CVCRT images and the ratio of the catheter occupying the internal jugular vein area (C/V ratio) by reassuming the images, were consistently collected. Logistic regression analysis using clinical factors was performed for the 2 groups divided according to morphologic severity.
Results:
Forty-seven patients were included in the study. CVCRT developed in 38 patients. Five graded types, ranging from wall-localized small thrombi to complete occlusion of the vein, were detected, and those who developed sheath-like thrombus were classified in to the severe group. Patients in the severe group were significantly younger and had higher C/V ratios. There were no significant differences in the surgical procedure, its difficulty, or postoperative severity score. Logistic regression analysis revealed the C/V ratio as the sole significant risk factor (odds ratio, 1.120; 95% CI, 1.01-1.24; P = .036).
Conclusions:
Our findings show the clinical implications of thrombus evaluation and morphologic classification to properly assess the risk factors of CVCRT in children with heart disease.
