Abstract 1796: Association Between Thromboembolic Complications and Increased Mortality After Pediatric Cardiac Surgery
Thromboembolic complications (TC) are life-threatening events in children. Pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are an especially high-risk for TCs. However, the association between TCs and surgical outcomes in these patients remains unclear. A total of 1,542 cardiac surgeries performed from September 2004 to December 2007 were reviewed. Clinical outcomes of patients with intra-venous, intra-arterial or intra-cardiac blood clots (collectively referred to as intra-vascular clots) after cardiac surgery were compared to those of patients without TCs in regression models (linear or logistic as appropriate) adjusted for age at operation, type and complexity of surgery. We identified a total 157/1542 (10%) patients with diagnostically-confirmed TCs. Of those patients, 102 (65%) patients had TCs in the venous vasculature only, 23 (15%) in the arterial vasculature only, 10 (6%) with intracardiac clots only and 22 (14%) with clots in multiple vascular systems. A total of 17 patients had a stroke (13 arterial, 4 sinovenous) and 4 had a pulmonary embolism. All cause in-hospital mortality was 23/157 (15%) in these patients. Autopsy report listed TCs as primary or secondary cause of death in 12/23 (52%) patients with TCs and in 12/57 (21%) of all death recorded in this cohort. Patients with either isolated intracardiac TCs or with TCs in multiple vascular systems had a significantly higher associated risk of cardiac arrest (31% vs. 14%, p=0.04) and mortality (31% vs. 10%, p=0.009) than those with isolated intra-venous or intra-arterial TCs. In multivariable regression models, intravascular TCs were independently associated with longer ICU stay (PE: +1.016 (0.025) log days, p<0.001), longer hospital stay (PE:+0.940 (0.019) log days, p<0.001), higher odds of cardiac arrest (OR: 6.9, 95%CI (3.2 – 14.6), p<0.001), all cause reoperation (OR: 4.4 (2.4 – 8.2), p<0.001) and higher odds of hospital death (OR: 2.8 (1.2 – 6.5), p<0.001). TCs after cardiac surgery affect an important proportion of patients after pediatric cardiac surgery and are strongly associated with poor clinical outcomes, including a significant contribution to mortality in these patients. Effective prevention and surveillance strategies are needed.