title: Risk, clinical features, and outcomes of thrombosis associated with pediatric cardiac surgery.
abstract: BACKGROUND
  Thrombosis, usually considered a serious but rare complication of pediatric cardiac surgery, has not been a major clinical and/or research focus in the past.
  
  
  RESULTS
  We noted 444 thrombi (66% occlusive, 60% symptomatic) in 171 of 1542 surgeries (11%). Factors associated with increased odds of thrombosis were age <31 days (odds ratio [OR], 2.0; P=0.002), baseline oxygen saturation <85% (OR, 2.0; P=0.001), previous thrombosis (OR, 2.6; P=0.001), heart transplantation (OR, 4.1; P<0.001), use of deep hypothermic circulatory arrest (OR, 1.9 P=0.01), longer cumulative time with central lines (OR, 1.2 per 5-day equivalent; P<0.001), and postoperative use of extracorporeal support (OR, 5.2; P<0.001). Serious complications of thrombosis occurred with 64 of 444 thrombi (14%) in 47 of 171 patients (28%), and were associated with thrombus location (intrathoracic, 45%; extrathoracic arterial, 19%; extrathoracic venous, 8%; P<0.001), symptomatic thrombi (OR, 8.0; P=0.02), and partially/fully occluding thrombi (OR, 14.3; P=0.001); indwelling access line in vessel (versus no access line) was associated with lower risk of serious complications (OR, 0.4; P=0.05). Thrombosis was associated with longer intensive care unit (+10.0 days; P<0.001) and hospital stay (+15.2 days; P<0.001); higher odds of cardiac arrest (OR, 4.9; P<0.001), catheter reintervention (OR, 3.3; P=0.002), and reoperation (OR, 2.5; P=0.003); and increased mortality (OR, 5.1; P<0.001). Long-term outcome assessment was possible for 316 thrombi in 129 patients. Of those, 197 (62%) had resolved at the last follow-up. Factors associated with increased odds of thrombus resolution were location (intrathoracic, 75%; extrathoracic arterial, 89%; extrathoracic venous, 60%; P<0.001), nonocclusive thrombi (OR, 2.2; P=0.01), older age at surgery (OR, 1.2 per year; P=0.04), higher white blood cell count (OR, 1.1/10(9) cells per 1 mL; P=0.002), and lower fibrinogen (OR, 1.4/g/L; P=0.02) after surgery.
  
  
  CONCLUSIONS
  Thrombosis affects a high proportion of children undergoing cardiac surgery and is associated with suboptimal outcomes. Increased awareness and effective prevention and detection strategies are needed.
authors.affiliation: The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8.
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.forename: Ines B
authors.initials: IB
authors.lastname: Menjak
authors.forename: Leonardo R
authors.initials: LR
authors.lastname: Brandão
authors.forename: Colleen E
authors.initials: CE
authors.lastname: Gruenwald
authors.forename: Steven M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: V Ben
authors.initials: VB
authors.lastname: Sivarajan
authors.forename: Hyaemin
authors.initials: H
authors.lastname: Yoon
authors.forename: Robert
authors.initials: R
authors.lastname: Maratta
authors.forename: Caitlin L
authors.initials: CL
authors.lastname: Carew
authors.forename: Janet A
authors.initials: JA
authors.lastname: McMullen
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Clarizia
authors.forename: Helen M
authors.initials: HM
authors.lastname: Holtby
authors.forename: Suzan
authors.initials: S
authors.lastname: Williams
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Caldarone
authors.forename: Glen S
authors.initials: GS
authors.lastname: Van Arsdell
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Chan
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009864:Ontario / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome