Abstract
The objectives of the present study were to determine whether there was any association between the grade of heart failure, as expressed by preoperative levels of brain natriuretic peptide and Ross score, and the preoperative coagulation status in patients with non-restrictive ventricular shunts and determine whether there were any postoperative disturbances of the coagulation system in these patients, as measured by thromboelastometry and standard laboratory analyses of coagulation. Perioperative coagulation was analysed with laboratory-based coagulation tests and thromboelastometry before, 8 hours after, and 18 hours after cardiac surgery. In addition, brain natriuretic peptide was analysed before and 18 hours after surgery. 40 children less than 12 months old with non-restrictive congenital ventricular or atrio-ventricular shunts scheduled for elective repair of their heart defects. All coagulation parameters measured were within normal ranges preoperatively. There was a significant correlation between brain natriuretic peptide and plasma fibrinogen concentration preoperatively. There was no statistically significant correlation between brain natriuretic peptide and INTEM-MCF, FIBTEM-MCF, plasma fibrinogen, activated partial thromboplastin time, prothrombin time, or platelet count at any other time point, either preoperatively or postoperatively. Postoperatively, fibrinogen plasma concentration and FIBTEM-MCF decreased significantly at 8 hours, followed by a large increase at 18 hours to higher levels than preoperatively. There was no evidence of children with non-restrictive shunts having coagulation abnormalities before cardiac surgery. Brain natriuretic peptide levels or Ross score did not correlate with coagulation parameters in any clinically significant way.
Highlights
The management of coagulopathy and bleeding during paediatric cardiac surgery is an integral part of the intraoperative patient care
Except for a very modest positive correlation between preoperative plasma fibrinogen and brain natriuretic peptide, there were no signs that the level of pro-brain natriuretic peptide might act as a marker of an abnormal coagulation capacity
This contrasts with a previous study by Osthaus et al[15], which found that mean Fibtem-MCF was lower in children with the same diagnoses as in our study, still within the normal reference range
Summary
The management of coagulopathy and bleeding during paediatric cardiac surgery is an integral part of the intraoperative patient care. Patients at risk of excessive bleeding would be identified before the surgery starts, to enable appropriate prophylactic measures. The attempts to find these patients using analysis of the coagulation system in blood have shown promising results in adults[1] but have mostly been disappointing in pediatric patients. One of the reasons for this may be that most study populations in paediatric cardiac surgery are relatively heterogenous, comprising patients of various ages and with different diagnoses.[2,3] An alternative approach to identify risk patients would be to look at the type of cardiac malformations that are thought to compromise the coagulation system even before surgery has begun.[4],
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