Perioperative Thromboembolic Complications after Cavo-pulmonary Connections_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

Pediatric Cardiovascular Surgery Center， Fu wai Hospital， Chinese Academy of Medical Sciences &;
Peking Union Medical College， Beijing 100037， P. R. China;

Corresponding author：

Keywords：

Pediatric Cardiovascular Surgery Center， Fu wai Hospital， Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100037， P. R. China

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Abstract：　Objective　To analyze the manifestation, treatment，outcome and potentially predisposing risk factors of perioperative thromboembolism after cavo-pulmonary connection, and to assess the effects of our prophylactic antithrombotic　strategy. Methods Clinical data of 264 cases of bidirectional Glenn and 224 cases of total cavopulmonary connection （TCPC） operations undertaken from September 2005 to December 2010 in Fu wai hospital were retrospectively analyzed.　Perioperative thromboembolic complications occurred in 9 patients. 5 of them were after bidirectional Glenn, 4 were after　TCPC. Most of the 9 patients had at least one thrombi-related risk factor. The routine prophylactic antithrombotic therapy　after these operations were intravenous infusion of heparin 10 U/（kg·h） initially, followed with oral aspirin 1-3 mg/（kg·d）.　Results　Thromboembolic events occurred within 7 days after the operation in 6 cases, appeared 2 to 4 weeks after the surgery in 3 cases. All 9 patients received anticoagulation with heparin. One patient also undertook take-down operation. 3 （33%） patients died, accounting for 33% （1/3）, and 18% （2/11） of the early deaths after bidirectional Glenn and TCPC operations. Clinical symptoms improved or disappeared in the remaining 6 patients.　Conclusion　The mortality of perioperative thromboembolic complications after cavo-pulmonary connection is high, consisting of the important cause of early deaths after these procedures. Our prophylactic anticoagulation strategy proved to be effective, though some thrombi-related
risk factors still need to be avoided.

Citation： Perioperative Thromboembolic Complications after Cavopulmonary Connections. Perioperative Thromboembolic Complications after Cavo-pulmonary Connections. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(4): 358-361. doi: Copy

1.	occluded cavopulmonary connections in infants and children. Interact Cardiovasc Thorac Surg, 2010, 10 （3）：383-388.
2.	Hedrick M, Elkins RC, Knott-Craig CJ, et al. Successful thrombectomy for thrombosis of the right side of the heart after the Fontan operation. Report of two cases and review of the literature. J Thorac Cardiovasc Surg, 1993, 105 （2）：297-301.
3.	Jahangiri M, Shore D, Kakkar V, et al. Coagulation factor abnormalities after the Fontan procedure and its modifications. J Thorac Cardiovasc Surg, 1997, 113 （6）：989-992.
4.	Shirai LK, Rosenthal DN, Reitz BA, et al. Arrhythmias and thromboembolic complications after the extracardiac Fontan operation. J Thorac Cardiovasc Surg, 1998, 115 （3）：499-505.
5.	Monagle P, Cochrane A, McCrindle, et al. Thromboembolic complications after Fontan procedures-the role of prophylactic anticoagulation. J Thorac Cardiovasc Surg, 1998, 115 （3）：493-498.
6.	Coon PD, Rychik J, Novello RT, et al. Thrombus formation after the Fontan operation. Ann Thorac Surg, 2001, 71 （6）：1990-1994.
7.	Ravn HB, Hjortdal VE, Stenbog EV, et al. Increased platelet reactivity and significant changes in coagulation markers after cavopulmonary connection. Heart, 2001, 85 （1）：61-65.
8.	Jacobs ML, Pourmoghadam KK, Geary EM, et al. Fontan’s operation： is aspirin enough? Is coumadin too much? Ann Thorac Surg, 2002, 73 （1）：64-68.
9.	Odegard KC, McGowan FX, Zurakowski D, et al. Procoagulant and anticoagulant factor abnormalities following the Fontan procedure：　increased factor VIII may predispose to thrombosis. J Thorac　Cardiovasc Surg, 2003, 125 （6）：1260-1267.
10.	Gupta A, Daggett C, Behera S, et al. Risk factors for persistent pleural effusions after the extracardiac Fontan procedure. J Thorac　Cardiovasc Surg, 2004, 127 （6）：1664-1669.
11.	Van den Bosch AE, Roos-Hesselink JW, Van Domberg, et al. Long-term outcome and quality of life in adult patients after the Fontan operation. Am J Cardiol, 2004, 93 （9）：1141-1145.
12.	Kaulitz R, Ziemer G, Rauch R, et al. Prophylaxis of thromboembolic complications after the Fontan operation （total cavopulmonary anastomosis）. J Thorac Cardiovasc Surg, 2005, 129 （3）：569-575.
13.	Bartz PJ, Driscoll DJ, Dearani JA, et al. Early and late results of the modified Fontan operation for heterotaxy syndrome 30 years of experience in 142 patients. J Am Coll Cardiol, 2006, 48 （11）：2301-2305.
14.	d’Udekem Y, Iyengar AJ, Cochrane AD, et al. the Fontan procedure：　contemporary techniques have improved long-term outcomes.　Circulation, 2007, 116 （suppl 1）：I157-I164.
15.	Khairy P, Fernandes SM, Mayer JE Jr, et al. Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation, 2008, 117 （1）：85-92.
16.	Jacobs ML, Pelletier GJ, Pourmoghadam KK, et al. Protocols associated with no mortality in 100 consecutive Fontan procedures. Eur J Cardiothorac Surg, 2008, 33 （4）：626-632.
17.	Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the　diagnosis and management of acute pulmonary embolism. Eur Heart J, 2008, 29 （18）：2276-2315.
18.	Tapson VF. Acute pulmonary embolism. N Engl J Med, 2008, 358 （10）：1037-1052.
19.	Monagle P, Chalmers E, Chan A, et al. Antithrombotic therapy in　neonates and children. American college of chest physicians evidence-based clinical practice guidelines （8th edition）. Chest, 2008, 133 （6）：887S-968S.
20.	Sreeram N, Emmel M, Trieschmann U, et al. Reopening acutely.
21.	Massicotte P, Julian JA, Gent M, et al. An open-label randomized controlled trial of low molecular weight heparin for the prevention of central venous line-related thrombotic complications in children： the PROTEKT trial. Thromb Res, 2003, 109 （2-3）：101-108.
22.	Hanslik A, Thom K, Haumer M, et al. Incidence and diagnosis of thrombosis in children with short-term central venous lines of the　upper venous system. Pediatrics, 2008, 122 （6）：1284-1291.

1. occluded cavopulmonary connections in infants and children. Interact Cardiovasc Thorac Surg, 2010, 10 （3）：383-388.
2. 　Hedrick M, Elkins RC, Knott-Craig CJ, et al. Successful thrombectomy for thrombosis of the right side of the heart after the Fontan operation. Report of two cases and review of the literature. J Thorac Cardiovasc Surg, 1993, 105 （2）：297-301.
3. 　Jahangiri M, Shore D, Kakkar V, et al. Coagulation factor abnormalities after the Fontan procedure and its modifications. J Thorac Cardiovasc Surg, 1997, 113 （6）：989-992.
4. 　Shirai LK, Rosenthal DN, Reitz BA, et al. Arrhythmias and thromboembolic complications after the extracardiac Fontan operation. J Thorac Cardiovasc Surg, 1998, 115 （3）：499-505.
5. 　Monagle P, Cochrane A, McCrindle, et al. Thromboembolic complications after Fontan procedures-the role of prophylactic anticoagulation. J Thorac Cardiovasc Surg, 1998, 115 （3）：493-498.
6. 　Coon PD, Rychik J, Novello RT, et al. Thrombus formation after the Fontan operation. Ann Thorac Surg, 2001, 71 （6）：1990-1994.
7. 　Ravn HB, Hjortdal VE, Stenbog EV, et al. Increased platelet reactivity and significant changes in coagulation markers after cavopulmonary connection. Heart, 2001, 85 （1）：61-65.
8. 　Jacobs ML, Pourmoghadam KK, Geary EM, et al. Fontan’s operation： is aspirin enough? Is coumadin too much? Ann Thorac Surg, 2002, 73 （1）：64-68.
9. 　Odegard KC, McGowan FX, Zurakowski D, et al. Procoagulant and anticoagulant factor abnormalities following the Fontan procedure：　increased factor VIII may predispose to thrombosis. J Thorac　Cardiovasc Surg, 2003, 125 （6）：1260-1267.
10. 　Gupta A, Daggett C, Behera S, et al. Risk factors for persistent pleural effusions after the extracardiac Fontan procedure. J Thorac　Cardiovasc Surg, 2004, 127 （6）：1664-1669.
11. 　Van den Bosch AE, Roos-Hesselink JW, Van Domberg, et al. Long-term outcome and quality of life in adult patients after the Fontan operation. Am J Cardiol, 2004, 93 （9）：1141-1145.
12. 　Kaulitz R, Ziemer G, Rauch R, et al. Prophylaxis of thromboembolic complications after the Fontan operation （total cavopulmonary anastomosis）. J Thorac Cardiovasc Surg, 2005, 129 （3）：569-575.
13. 　Bartz PJ, Driscoll DJ, Dearani JA, et al. Early and late results of the modified Fontan operation for heterotaxy syndrome 30 years of experience in 142 patients. J Am Coll Cardiol, 2006, 48 （11）：2301-2305.
14. 　d’Udekem Y, Iyengar AJ, Cochrane AD, et al. the Fontan procedure：　contemporary techniques have improved long-term outcomes.　Circulation, 2007, 116 （suppl 1）：I157-I164.
15. 　Khairy P, Fernandes SM, Mayer JE Jr, et al. Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation, 2008, 117 （1）：85-92.
16. 　Jacobs ML, Pelletier GJ, Pourmoghadam KK, et al. Protocols associated with no mortality in 100 consecutive Fontan procedures. Eur J Cardiothorac Surg, 2008, 33 （4）：626-632.
17. 　Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the　diagnosis and management of acute pulmonary embolism. Eur Heart J, 2008, 29 （18）：2276-2315.
18. 　Tapson VF. Acute pulmonary embolism. N Engl J Med, 2008, 358 （10）：1037-1052.
19. 　Monagle P, Chalmers E, Chan A, et al. Antithrombotic therapy in　neonates and children. American college of chest physicians evidence-based clinical practice guidelines （8th edition）. Chest, 2008, 133 （6）：887S-968S.
20. 　Sreeram N, Emmel M, Trieschmann U, et al. Reopening acutely.
21. 　Massicotte P, Julian JA, Gent M, et al. An open-label randomized controlled trial of low molecular weight heparin for the prevention of central venous line-related thrombotic complications in children： the PROTEKT trial. Thromb Res, 2003, 109 （2-3）：101-108.
22. 　Hanslik A, Thom K, Haumer M, et al. Incidence and diagnosis of thrombosis in children with short-term central venous lines of the　upper venous system. Pediatrics, 2008, 122 （6）：1284-1291.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative Thromboembolic Complications after Cavo-pulmonary Connections

Abstract Full text Figures/Tables Video References Cited by

Format

Content