Wise-Faberowski Lisa, Irvin Matthew, Quinonez Zoel A, Long Jin, Asija Ritu, Margetson Tristan D, Hanley Frank L, McElhinney Doff B
Department of Anesthesiology, Lucile Packard Children's Hospital Heart Center, Stanford University, Stanford, CA, USA.
Clinical and Translational Research Program, Lucile Packard Children's Hospital Heart Center, Stanford University, Stanford, CA, USA.
World J Pediatr Congenit Heart Surg. 2020 Mar;11(2):159-165. doi: 10.1177/2150135119892192.
Surgical repair of tetralogy of Fallot and major aortopulmonary collaterals (TOF/MAPCAs) involves unifocalization of MAPCAs and reconstruction of the pulmonary arterial circulation. Surgical and cardiopulmonary bypass (CPB) times are long and suture lines are extensive. Maintaining patency of the newly anastomosed vessels while achieving hemostasis is important, and assessment of transfusion practices is critical to successful outcomes.
Clinical, surgical, and transfusion data in patients with TOF/MAPCAs repaired at our institution (2013-2018) were reviewed. Types and volumes of blood products used in the perioperative period, in addition to the use of antifibrinolytics and/or procoagulants (factor VIII inhibitor bypassing activity [FEIBA]; anti-inhibitor coagulant complex), were assessed. Outcome measures included days on mechanical ventilation (DOMV), postoperative intensive care unit and hospital length of stay (LoS), and incidence of thrombosis.
Perioperative transfusion data from 279 patients were analyzed. Surgical (879 ± 175 minutes vs 684 ± 257 minutes) and CPB times (376 ± 124 minutes vs 234 ± 122 minutes) were longer in patients who received FEIBA than those who did not. Although the indexed volume of packed red blood cells (128.4 ± 82.2 mL/kg) and fresh frozen plasma (64.2 ± 41.1 mL/kg) was similar in patients who did and did not receive FEIBA, the amounts of cryoprecipitate (5.5 ± 5.2 mL/kg vs 5.8 ± 4.8 mL/kg) and platelets (19.5 ± 20.7 mL/kg vs 20.8 ± 13 mL/kg) transfused were more in those who did receive FEIBA.
Perioperative transfusion is an important component in the overall surgical and anesthetic management of patients with TOF/MAPCAs. The intraoperative use of FEIBA was not associated with a decrease in the amount of blood products transfused, DOMV, or LoS or with an increase in thrombotic complications.
法洛四联症合并主要体肺侧支血管（TOF/MAPCAs）的外科修复包括体肺侧支血管的单源化和肺动脉循环的重建。手术和体外循环（CPB）时间长，缝合线广泛。在实现止血的同时保持新吻合血管的通畅很重要，输血实践的评估对成功的结果至关重要。
回顾了在我们机构（2013 - 2018年）接受TOF/MAPCAs修复的患者的临床、手术和输血数据。评估围手术期使用的血液制品的类型和用量，以及抗纤溶药物和/或促凝剂（因子VIII抑制剂旁路活性[FEIBA]；抗抑制剂凝血复合物）的使用情况。结果指标包括机械通气天数（DOMV）、术后重症监护病房和住院时间（LoS）以及血栓形成的发生率。
分析了279例患者的围手术期输血数据。接受FEIBA的患者的手术时间（879±175分钟对684±257分钟）和CPB时间（376±124分钟对234±122分钟）比未接受FEIBA的患者更长。虽然接受和未接受FEIBA的患者的红细胞压积容积指数（128.4±82.2 mL/kg）和新鲜冰冻血浆（64.2±41.1 mL/kg）相似，但接受FEIBA的患者输注的冷沉淀量（5.5±5.2 mL/kg对5.8±4.8 mL/kg）和血小板量（19.5±20.7 mL/kg对20.8±13 mL/kg）更多。
围手术期输血是TOF/MAPCAs患者整体手术和麻醉管理的重要组成部分。术中使用FEIBA与输注的血液制品量减少、DOMV或LoS降低或血栓形成并发症增加无关。
