Cyanotic congenital heart disease (CCHD): focus on hypoxemia, secondary erythrocytosis, and coagulation alterations

Zabala, Luis; Guzzetta, Nina A.

doi:10.1111/pan.12705

Cited by 63 publications

(37 citation statements)

References 51 publications

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“…[5] In this study, the average of the preoperative hematocrit was lower as compared to other values reported in previous studies. [367810]…”

Section: Discussioncontrasting

confidence: 50%

“…[5] It is known that blood loss is related with the degree of anatomic and physiologic impairment in patients with TOF,[5] however, it has been difficult to establish a predictive model for postoperative blood loss using simple laboratory test and intraoperative characteristics. [1] We hypothesized that preoperative hematological conditions can be useful to predict postoperative blood loss and it might even be associated with short-term mortality.…”

Section: Introductionmentioning

confidence: 99%

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The utility of preoperative level of erythrocytosis in the prediction of postoperative blood loss and 30-day mortality in patients with tetralogy of fallot

2017

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Background:Postoperative major bleeding is a relatively common complication of patients undergoing corrective surgery of tetralogy of Fallot (TOF). Life-threatening blood losses can lead to aggressive transfusions or reoperation. Little is known about the risk factors associated with a bleeding tendency in TOF patients. This study aimed to establish predictive models for postoperative blood loss and mortality in TOF patients.Methods:We conducted a retrospective observational study involving patients with TOF who were posted for corrective cardiac surgery in a single hospital between 2010 and 2015. Hospital records including sociodemographic, pre- and intra-operative characteristics were extracted. Postoperative blood loss (within 24 and 48 h) and 30-day mortality were the primary and secondary outcomes, respectively. Multivariate linear and logistic regression models were used to identify determinants of outcomes.Results:A total of 60 patients were included in this study. The median age was 1 year (interquartile range = 0.62–5) and the male to female ratio of 1.7:1. Mean postoperative blood loss within 24 h was 283 ± 212 mL. In multivariate linear regression, preoperative hematocrit (β = 6.63, P = 0.042) and duration of intraoperative oxygenator with CPB (β = 5.16, P = 0.025) were significantly correlated with postoperative blood loss within 24 h. After adjusting for sociodemographic, intra- and post-operative characteristics, preoperative hematocrit (odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.01–1.21), and postoperative red blood cell transfusions (OR = 3.88, 95% CI = 1.16–12.9) showed statistically significant association with 30-day mortality. The area under the receiver operating characteristic curve of the multivariable model was 0.863.Conclusions:Preoperative levels of erythrocytosis appear to predict postoperative blood loss and short-term mortality in TOF patients undergoing corrective surgery.

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“…[5] In this study, the average of the preoperative hematocrit was lower as compared to other values reported in previous studies. [367810]…”

Section: Discussioncontrasting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

The utility of preoperative level of erythrocytosis in the prediction of postoperative blood loss and 30-day mortality in patients with tetralogy of fallot

2017

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“…Cyanotic heart disease can impact the coagulation system. 20 Whether this will result in an increased need for transfusion of allogeneic blood products is not yet fully elucidated. In a retrospective study, Faraoni and Van der Linden 21 showed that postoperative blood loss was increased in cyanotic infants between 1 and 6 months of age when compared with a noncyanotic group, but this difference was no longer observed after the age of 6 months.…”

Section: Discussionmentioning

confidence: 99%

Fresh Frozen PlasmaversusCrystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

et al. 2020

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Background: In congenital cardiac surgery, priming cardiopulmonary bypass (CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation abnormalities. The hypothesis was that CPB priming with crystalloids would be different compared with FFP in terms of bleeding and/or need for blood product transfusion. Methods: In this parallel-arm double-blinded study, patients weighing between 7 and 15 kg were randomly assigned to a CPB priming with 15 ml • kg −1 PlasmaLyte or 15 ml • kg −1 FFP in addition to a predefined amount of packed red blood cells used in all patients. The decision to transfuse was clinical and guided by point-of-care tests. The primary endpoints included postoperative bleeding tracked by chest tubes, number of patients transfused with any additional blood products, and the total number of additional blood products administered intra-and postoperatively. The postoperative period included the first 6 h after intensive care unit arrival. results: Respectively, 30 and 29 patients in the FFP and in the crystalloid group were analyzed in an intention-to-treat basis. Median postoperative blood loss was 7.1 ml • kg −1 (5.1, 9.4) in the FFP group and 5.7 ml • kg −1 (3.8, 8.5) in the crystalloid group (P = 0.219); difference (95% CI): 1.2 (−0.7 to 3.2). The proportion of patients additionally transfused was 26.7% (8 of 30) and 37.9% (11 of 29) in the FFP and the crystalloid groups, respectively (P = 0.355; odds ratio [95% CI], 1.7 [0.6 to 5.1]). The median number of any blood products transfused in addition to priming was 0 (0, 1) and 0 (0, 2) in the FFP and crystalloid groups, respectively (P = 0.254; difference [95% CI], 0 [0 to 0]). There were no study-related adverse events. conclusions: The results demonstrate that in infants and children, priming CPB with crystalloids does not result in a different risk of postoperative bleeding and need for transfusion of allogeneic blood products.

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“…The altered anatomy of a CHD heart can be further complicated by the persistence of fetal shunt pathways, pathological flow patterns and hypoxemia (16)(17)(18). As such, the growing heart is particularly vulnerable to multi-factorial perinatal stresses.…”

Section: Introductionmentioning

confidence: 99%

Wnt11 regulates cardiac chamber development and disease during perinatal maturation

Touma¹,

Kang²,

Gao³

et al. 2017

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Cyanotic congenital heart disease (CCHD): focus on hypoxemia, secondary erythrocytosis, and coagulation alterations

Cited by 63 publications

References 51 publications

The utility of preoperative level of erythrocytosis in the prediction of postoperative blood loss and 30-day mortality in patients with tetralogy of fallot

The utility of preoperative level of erythrocytosis in the prediction of postoperative blood loss and 30-day mortality in patients with tetralogy of fallot

Fresh Frozen PlasmaversusCrystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

Wnt11 regulates cardiac chamber development and disease during perinatal maturation

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