New research and changing paradigms of coagulopathy in children after cardiac surgery: A narrative review

Abstract

Background: Congenital heart disease (CHD) is a disorder and abnormality of the heart or the great vessels of the thorax, which usually occurs during fetal development. It has been reported that CHD is a common condition. Nearly 25% of newborns with critical types of CHD require surgical intervention in the first year of life. Hence, increasing numbers of the annually conducted cardiopulmonary bypass (CPB) cardiac surgeries are usually associated with postoperative bleeding and coagulopathy. Bleeding after CPB usually requires a replacement therapy, including the transfusion of whole blood, red blood cells, coagulation factors, or platelets. Aim: to identify the pathophysiology of coagulopathy following cardiac surgery, how it impacts the clinical outcomes, and the available management options. Methods: In this review, we only included English articles from common electronic databases such as PubMed /MEDLINE, Web of Science, Scopus, and the Cochrane Library with the keywords "congenital heart disease", "cardiac surgery" combined with keywords involving "coagulopathy" The end date for this review is February 2022. Scientific novelty: This review aims to briefly review the problem of post-CPB bleeding in the pediatric population regarding multiple aspects. The medical literature lacks a comprehensive review regarding the problem of CHD, its prevalence, types, surgical options, post-cardiac surgery complications such as coagulopathy, the pathophysiology of the coagulopathy, and the preventive and therapeutic measures. The practical significance of the result obtained: This review may help surgeons and pediatricians deeply understand post-CPB coagulopathy's pathophysiology and how to anticipate, prevent, and manage it properly. Antifibrinolytic pharmaceuticals represent the mainstay for managing this problem; their administration during CPB reduces the risk of postoperative bleeding. Blood component transfusion is also an alternative option. Conclusion: Post-cardiac surgery, coagulopathy, and bleeding are major problems facing cardiothoracic surgeons. Postoperative bleeding, especially in the pediatric population, is one of the common causes of surgical re-exploration, leading to a higher risk of morbidities and mortalities. Meticulous preoperative examination, investigation, and intraoperative protective measures are important factors in avoiding and properly managing postoperative bleeding risk.