title: Hemorrhage requiring surgical intervention among children on pulsatile ventricular assist device support.
abstract: Bleeding complications are a source of morbidity after Berlin EXCOR VAD implantation yet remain poorly characterized. We evaluated our experience to describe the bleeding complications among pediatric VAD recipients. We hypothesized that those with bleeding requiring exploration had abnormal coagulation profile compared with those without bleeding. The retrospective study included 43 consecutive patients with end-stage heart failure supported on pediatric mechanical cardiac support as a bridge to transplantation. Day-/event-based analysis on factors below associated with (i) bleeding and (ii) bleeding in next 48 h. Cases with bleeding were compared with day-matched patients without bleeding complications. Among 43 subjects bleeding occurred in 47% of cases, which necessitated exploration or chest tube placement. Twenty of 34 interventions for bleeding occurred in the first seven post-operative days. No differences in coagulation parameters or use of antiplatelet agents were noted among those who had bleeding vs. those who did not. Our results indicate that (i) re-bleeding requiring re-exploration was common, (ii) most of the bleeding occurred early post-implantation, (iii) there were no differences in coagulation parameters or the use of antiplatelet agents within 48 h of bleeding compared with those who did not bleed on each successive post-operative day.
authors.affiliation: Department of Pediatrics, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, AR, USA.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Byrnes
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Frazier
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
authors.forename: Brian
authors.initials: B
authors.lastname: Eble
authors.forename: Alyssa
authors.initials: A
authors.lastname: McKamie
authors.forename: Alberto
authors.initials: A
authors.lastname: Gomez
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
mesh_terms: D000293:Adolescent; D001778:Blood Coagulation Disorders / Q000150:complications; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy
keywords: bleeding; circulatory support devices; pediatric; reoperation (thoracic)