title: The use fibrinogen/thrombin-coated equine collagen patch in children requiring reoperations for congenital heart disease. A single center clinical experience.
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacy and cost-effectiveness of fibrinogen/thrombin-coated collagen patch (FTCCP)(TachoSil®) during intraoperative hemostasis in patients with congenital heart disease, who required a reoperation during childhood.
  
  
  METHODS
  We reviewed data on the intraoperative blood product requirements and hospital costs of children (age <16 years) who underwent a reoperation for treating their congenital heart disease between January 2009 and December 2011.
  
  
  RESULTS
  One-hundred and seventeen patients were included. Median age at surgery was 2.1 years (range 3 days-14.1 years). Main causes of intraoperative bleeding were: 1) reinforcement of suture lines (106 patients, 90.6%); 2) lung lesions (5 patients, 4.2%); 3) epicardial lesions (3 patients, 2.6%); and 4) chest wall lesions (3 patients, 2.6%). At logistic regression the amount of packed red blood cells (PRBC) requirement was significantly higher in patients with preoperative cyanosis (P=0.008, OR=3.85) and in patients who required the use of cardiopulmonary bypass (P=0.005, OR=21.19). The use of FTCCP (N.=90 patients) as first line treatment was significantly associated with a lower PRBC requirement (P=0.0003, OR=0.1) which in addition to the avoidance of other hemostatic/sealant agents, leads to lower hospital cost.
  
  
  CONCLUSIONS
  FTCCP is an effective hemostatic agent which can be safely used during the hemostasis of children requiring reoperations for their congenital heart malformations. When used as first line treatment, with specific indications, FTCCP limited the intraoperative PRBC requirement and the use of other hemostatic/sealant agents thus reducing hospital costs.
authors.affiliation: Pediatric and Congenital Cardiac Surgery Unit Department of Cardiac, Thoracic and Vascular Surgery University of Padua, Padua, Italy - vladimirovida@yahoo.it.
authors.forename: V L
authors.initials: VL
authors.lastname: Vida
authors.forename: M
authors.initials: M
authors.lastname: De Franceschi
authors.forename: E
authors.initials: E
authors.lastname: Barzon
authors.forename: M A
authors.initials: MA
authors.lastname: Padalino
authors.forename: F
authors.initials: F
authors.lastname: Scattolin
authors.forename: G
authors.initials: G
authors.lastname: Stellin
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D016527:Drug Costs; D017707:Erythrocyte Transfusion; D005260:Female; D005340:Fibrinogen / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006330:Heart Defects, Congenital / Q000191:economics / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D006490:Hemostatics / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D017713:Platelet Transfusion; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013917:Thrombin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; D006490:Hemostatics; C518955:TachoSil; D005340:Fibrinogen; D013917:Thrombin