Coagulation abnormalities and liver function after hemi-Fontan and Fontan procedures - the importance of hemodynamics in the early postoperative period.
BACKGROUND
The causes of coagulation abnormalities and thromboembolic complications during staged Fontan approach in patients with single ventricle remain unclear. This study was designed to evaluate the coagulation profile in the early postoperative period after hemi-Fontan and Fontan procedures with relationship to liver function and hemodynamic variables.


METHODS
The prospective study on 43 patients after hemi-Fontan (group 1) and 37 patients after Fontan procedure (group 2) was carried out. Coagulation profile (factor VII, factor VIII, ATIII, fibrinogen, prothrombin), liver function (total serum protein, albumin, AST, ALT, bilirubin), and hemodynamic variables were assessed on postoperative day 1 and 5 and compared to preoperative measures.


RESULTS
Factor VIII concentration was significantly higher on first postoperative day in both groups. On postoperative day 5 the concentration of factor VIII was significantly decreased in group 1 whereas constant in group 2. The concentration of factor VII, ATIII, fibrinogen, and prothrombin was significantly decreased on first and increased on fifth postoperative day after both hemi-Fontan and Fontan procedures. The increase in bilirubin concentration was more distinctive after Fontan operation (p=0.003) with lower AST in this group (p<0.0001). The single ventricle function, pO2 and central venous pressure had significant influence on factor VIII (p=0.034), factor VII (p=0.012), ATIII (p=0.006), and prothrombin (p=0.024) concentrations in group 2 with no significant influence in group 1.


CONCLUSIONS
The distinctive causes of coagulation abnormalities during staged Fontan approach are hemodynamic changes and temporary liver dysfunction. Elevated concentration of factor VIII and significant influence of hemodynamics on coagulation profile could contribute to postoperative thromboembolic complications.
Procelewska
Malgorzata
M
Department of Pediatric Cardiac Surgery, Polish-American Children's Hospital Collegium Medicum Jagiellonian University, 30-663 Kraków, ul.Wielicka 265, Poland.
Kolcz
Jacek
J
Januszewska
Katarzyna
K
Mroczek
Tomasz
T
Malec
Edward
E
D000990:Antithrombin III / Q000032:analysis; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D001798:Blood Proteins / Q000032:analysis; D005167:Factor VII / Q000032:analysis; D005169:Factor VIII / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008099:Liver / Q000503:physiopathology*; D008111:Liver Function Tests / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D011516:Prothrombin / Q000032:analysis; D013923:Thromboembolism / Q000209:etiology / Q000503:physiopathology
D001798:Blood Proteins; D000990:Antithrombin III; D005167:Factor VII; D011516:Prothrombin; D005169:Factor VIII; D005340:Fibrinogen; D001219:Aspartate Aminotransferases; D001663:Bilirubin