Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta Department of Pediatrics Emory University Atlanta GA.
Department of Pediatrics School of Medicine Emory University Atlanta GA.
J Am Heart Assoc. 2020 Dec 15;9(24):e015882. doi: 10.1161/JAHA.120.015882. Epub 2020 Dec 7.
Background Thrombosis is common in infants undergoing staged surgeries for single-ventricle congenital heart disease. The reported incidence and timing of thrombosis varies widely, making it difficult to understand the burden of thrombosis and develop approaches for prevention. We aimed to determine the timing and cumulative incidence of thrombosis following the stage I Norwood procedure and identify clinical characteristics associated with thrombosis. Methods and Results We analyzed data from the Pediatric Heart Network Single Ventricle Reconstruction trial from 2005 to 2009 and identified infants with first-time thrombotic events. In 549 infants, the cumulative incidence of thrombosis was 21.2% (n=57) from stage I through stage II. Most events occurred during stage I (n=35/57, 65%), with a median time to thrombosis of 15 days. We used a Cox proportional hazards model to estimate the association of clinical variables with thrombosis. After adjusting for baseline variables, boys had a higher hazard of thrombosis (adjusted hazard ratio [HR], 2.69; 95% CI, 1.44-5.05; =0.002), non-hypoplastic left heart syndrome cardiac anatomy was associated with a higher early hazard of thrombosis (adjusted HR, 3.93; 95% CI, 1.89-8.17; <0.001), and longer cardiopulmonary bypass time was also associated with thrombosis (per 10-minute increase, adjusted HR, 1.07; 95% CI, 1.01-1.12; =0.02). Lower oxygen saturation after the Norwood procedure increased the hazard for thrombosis in the unadjusted model (HR, 1.08; 95% CI, 1.02-1.14; =0.011). Conclusions Thrombosis affects 1 in 5 infants through Stage II discharge, with most events occurring during stage I. Male sex, non-hypoplastic left heart syndrome anatomy, longer cardiopulmonary bypass time, and lower stage I oxygen saturation were associated with thrombosis.
背景 在接受单心室先天性心脏病分期手术的婴儿中，血栓形成很常见。血栓形成的报告发生率和时间差异很大，因此难以了解血栓形成的负担并制定预防方法。我们旨在确定在 I 期 Norwood 手术后血栓形成的时间和累积发生率，并确定与血栓形成相关的临床特征。
方法和结果 我们分析了 2005 年至 2009 年儿科心脏网络单心室重建试验的数据，并确定了首次发生血栓事件的婴儿。在 549 名婴儿中，从 I 期到 II 期，血栓形成的累积发生率为 21.2%（n=57）。大多数事件发生在 I 期（n=35/57，65%），血栓形成的中位时间为 15 天。我们使用 Cox 比例风险模型估计临床变量与血栓形成的关联。在校正基线变量后，男孩发生血栓形成的风险更高（调整后的危险比[HR]，2.69；95%CI，1.44-5.05；=0.002），非左心发育不良综合征心脏解剖结构与早期血栓形成的风险更高相关（调整后的 HR，3.93；95%CI，1.89-8.17；<0.001），体外循环时间延长也与血栓形成相关（每增加 10 分钟，调整后的 HR，1.07；95%CI，1.01-1.12；=0.02）。Norwood 手术后较低的血氧饱和度增加了未经调整模型中血栓形成的风险（HR，1.08；95%CI，1.02-1.14；=0.011）。
结论 血栓形成影响 1 期至 2 期出院婴儿的 1/5，大多数事件发生在 I 期。男性、非左心发育不良综合征解剖结构、体外循环时间延长和 I 期血氧饱和度较低与血栓形成相关。
