Introduction: Congenital heart surgery is often complicated by postoperative thrombosis which can lead to substantial morbidity and mortality(1). The estimated incidence of thrombosis in patients with congenital heart disease is 3-30% significantly more than other hospitalized children. Cardiac surgical patients less than 1 year of age have an even higher risk of postoperative thrombosis(1). Purpose: While the etiologies of thrombosis in pediatric cardiac surgery patients are complex, we sought to identify specific risk factors for thrombosis in neonates and infants who are at the highest risk for thrombotic complications. Methods: After IRB approval, we queried our internal Society of Thoracic Surgery (STS)-Congenital Cardiac Anesthesia (CCAS) database to identify all patients under 12 months of age who underwent cardiac surgery from January 1, 2015 through December 31, 2017. Demographic information, perioperative information, and outcomes, including thrombosis were collected. We identified patients who experienced a thrombotic event during the same hospital stay and confirmed the diagnosis with positive imaging studies. Using Chi-Square test or Wilcoxon rank-sum tests, we compared patients with thrombosis and those without to determine variables that contribute to postoperative thrombosis. Results: The incidence of thrombotic complications was 6.4% (78/1223) in patients under 1 year of age who underwent cardiac surgery with and without CPB at our institution. The most common sites of thrombosis were femoral artery or vein (29% and 27.5%). In the univariate analysis, perioperative risk factors included younger age; lower weight; prior surgery; higher STAT score; cyanosis; longer CPB time; higher hematocrit and higher lactate on CICU arrival (Figure 1). Using a multivariate logistic regression model, younger age, prior surgery, and STAT score 4 or 5 remained independently associated with postoperative thrombosis (Figure 2). Hospital length of stay was significantly longer in patients with thrombosis (45 days [19,85] versus 11 days [5,23]; p < 0.001). Conclusion: Children under 1 year of age are at increased risk for postoperative thrombotic complications after cardiac surgery. The risk is increased in younger patients, patients with multiple surgeries, and patients with higher risk surgeries. Patients who experience a postoperative thrombotic event have a significantly longer hospital stay. Reference 1.Manlhiot C, Menjak IB, Brandao LR, et al. Risk, clinical features, and outcomes of thrombosis associated with pediatric cardiac surgery. Circulation 2011;124:1511–9.

Perioperative variables associated with thrombosis in patient under 1 year of age undergoing cardiac surgery

Groups were compared with Chi-Square tests for categorical variables and Wilcoxon-rank sum test for continuous variables. (Values reported as N (%) or Median [25th percentile-75th percentile])

Perioperative variables associated with thrombosis in patient under 1 year of age undergoing cardiac surgery

Groups were compared with Chi-Square tests for categorical variables and Wilcoxon-rank sum test for continuous variables. (Values reported as N (%) or Median [25th percentile-75th percentile])

Close modal

Variables from multivariate logistic regression analysis associated with thrombotic complications in cardiac surgery patients under 1 year of age

Variables from multivariate logistic regression analysis associated with thrombotic complications in cardiac surgery patients under 1 year of age

Close modal