Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Ann Thorac Surg. 2013 Aug;96(2):651-6. doi: 10.1016/j.athoracsur.2013.04.061. Epub 2013 Jun 26.
Incidence of thrombosis in neonates undergoing cardiac surgery is as high as 20%, and single ventricle physiology (SVP) may present an even higher risk. We hypothesize that SVP is a risk factor for thrombosis in neonates undergoing cardiac surgery, and hypercoagulability biomarkers are predictive of postoperative thrombosis.
Records of 512 neonates undergoing cardiac surgery were retrospectively reviewed. Thrombosis was defined by clinical events (shunt thrombosis, limb ischemia, and stroke) or intravascular or cardiac thrombus by echocardiography. Clinical variables, including SVP and cardiopulmonary bypass (CPB), were analyzed using multivariable logistic regression. A hypercoagulability biomarker panel was obtained in a subset of patients with SVP and compared between neonates with and without thrombosis.
Thrombosis was detected in 51 of 512 neonates undergoing cardiac surgery. Intensive care and hospital lengths of stay were longer in patients who experienced thrombosis compared with those who did not (14 ± 13 vs 6 ± 1 days, 23 ± 4 vs 13 ± 1 days, p < 0.001). The SVP and use of CPB were significant risk factors for thrombosis, and the rate of thrombosis in SVP patients was 16.2% (16 of 99) compared with 8.5% (35 of 413) in non-SVP patients (p = 0.038). Thrombin generation, plasminogen activator inhibitor, and thrombin activatable fibrinolysis inhibitor were significantly elevated in SVP patients with thrombosis compared to without thrombosis (p < 0.05).
Single ventricle physiology patients are at higher risk for thrombosis compared with other neonates after cardiac surgery. Hypercoagulable panel testing may help risk stratify patients and guide patient specific anticoagulation management in the postoperative period.
行心脏手术的新生儿的血栓发生率高达 20%，而单心室生理学（SVP）可能存在更高的风险。我们假设 SVP 是行心脏手术的新生儿发生血栓的一个危险因素，且高凝生物标志物可预测术后血栓形成。
回顾性分析了 512 例行心脏手术的新生儿的病历。血栓形成定义为临床事件（分流血栓形成、肢体缺血和中风）或通过超声心动图检测到血管内或心脏血栓形成。使用多变量逻辑回归分析了 SVP 和体外循环（CPB）等临床变量。对 SVP 患儿进行了高凝生物标志物检测，并比较了血栓形成组与无血栓形成组患儿的结果。
512 例行心脏手术的新生儿中有 51 例发生了血栓。与无血栓形成的患儿相比，发生血栓的患儿的重症监护病房和住院时间更长（14 ± 13 天比 6 ± 1 天，23 ± 4 天比 13 ± 1 天，p < 0.001）。SVP 和 CPB 的使用是血栓形成的显著危险因素，SVP 患儿的血栓形成率为 16.2%（99 例中的 16 例），而非 SVP 患儿的血栓形成率为 8.5%（413 例中的 35 例）（p = 0.038）。与无血栓形成的 SVP 患儿相比，发生血栓的 SVP 患儿的凝血酶生成、纤溶酶原激活物抑制剂和血栓调节蛋白激活的纤溶抑制物明显升高（p < 0.05）。
与心脏手术后的其他新生儿相比，SVP 患儿发生血栓的风险更高。高凝状态标志物检测可能有助于对患者进行风险分层，并指导术后个体化抗凝管理。
