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Transthoracic intracardiac line use and complications in the paediatric single ventricle population
Nina Zook1, Justin Kochanski1, Shilpa Vellore Govardhan2
1Department of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA.
Insights
Transthoracic intracardiac lines are safe for paediatric cardiothoracic surgery, especially in single ventricle patients. Surgical shunts increased complication risk, suggesting careful consideration for these lines.
Area of Science:
- Cardiovascular Surgery
- Pediatric Critical Care
- Medical Device Safety
Background:
- Transthoracic intracardiac lines offer vital postoperative access in pediatric cardiothoracic surgery.
- Vascular preservation is critical for future interventions in single ventricle patients.
- Limited data exists on transthoracic line complications in this population.
Purpose of the Study:
- To evaluate the safety and complication rates of transthoracic intracardiac lines in pediatric single ventricle patients.
- To identify factors associated with complications, including infection, thrombosis, malfunction, and migration.
- To assess the suitability of transthoracic lines as an alternative to other central venous access methods.
Main Methods:
- Retrospective review of pediatric single ventricle patients undergoing cardiothoracic surgery.
- Data collected from 2011 to 2018 at a tertiary children's hospital.
- Analysis of 338 transthoracic lines, focusing on complication types and associated factors.
Main Results:
- Overall complication rate was 6.2% (21/338 lines).
- Most common complications included migration (2.4%) and thrombosis (2.1%).
- Presence of a surgical shunt was significantly associated with increased line complications (OR 2.58, P=0.03).
Conclusions:
- Transthoracic intracardiac lines demonstrate a favorable safety profile in pediatric single ventricle patients.
- These lines can be considered a primary alternative to other central lines in this population.
- Further prospective studies are needed to optimize outcomes and protocols.
Abstract:
Transthoracic intracardiac lines provide a unique access point for postoperative monitoring and management in paediatric cardiothoracic surgeries, particularly within the single ventricle population where preserving vasculature is crucial for future interventions. This retrospective review examined paediatric single ventricle patients undergoing cardiothoracic surgeries at a tertiary children's hospital between 2011 and 2018, focusing on the use of and factors associated with transthoracic line complications (infection, thrombosis, malfunction, and migration). A total of 338 lines were placed during the study period, with the majority occurring during palliative surgeries (86.5%). Lines remained in place for a median of 14 days postoperatively. Complications occurred in 21 lines (6.2%), comprising 8 migrations (2.4%), 7 thrombosis (2.1%), 4 malfunctions (1.2%), and 2 infections (0.6%). The presence of a surgical shunt was significantly associated with line complications (odds ratio 2.58, confidence interval 1.05 - 6.31; P 0.03). The use of transthoracic intracardiac lines seems to be safe and should be considered as a primary alternative to other central lines in the single ventricle population. A prospective assessment of transthoracic line complications, along with delineation of unit protocols, may further enhance outcomes in this complex population.
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