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A prognostic model for thrombotic complications after pediatric cardiac surgery

https://doi.org/10.15690/rpj.v1i4.2190

Abstract

Background. Cardiac surgery performed on pediatric patients with the use of artificial blood circulation (ABC) is accompanied by hemodilution, hypothermia and blood contact with artificial surfaces, as well as surgical trauma. All the above lead to endothelial cell injury, platelet aggregation and degranulation, activation of innate immunity, development of systemic inflammation and consumption of clotting, anti-coagulation and fibrinolytic factors, which is ultimately associated with the occurrence of thrombotic complications.

Objective. The study aimed at developing a mathematical model for the prognosis of thrombotic complications in children which had undergone the ABC, based on assessment of their clinical and laboratory parameters.

Methods. We have assessed clinical and laboratory data obtained from 153 children (newborn to 11 months 29 days of age) which had undergone cardiac surgery under conditions of ABC due to congenital heart defects (CHD). For all patients the general clinical and laboratory parameters: complete blood count, comprehensive metabolic panel, parameters of screening coagulogram, D-dimer concentration, von Willebrand factor activity, levels of antithrombin III, plasminogen, protein C and protein S, alpha-2-antiplasmin, thrombin activatable fibrinolysis inhibitor (TAFI) and fibrin-monomer have been assessed.

Results. In 43 patients (28.1%) post-operative thromboses have been diagnosed. Examination of children revealed the presence of thrombosis of various localization including the intracardiac thrombi, ischemic cerebrovascular events, limb ischemia, etc. Based on logistic regression analysis, a model of development of thrombotic complications has been built which included 4 parameters: activity of lactate dehydrogenase (LDH), TAFI activity, von Willebrand factor activity and protein C activity. Model sensitivity was 95.3%, and its specificity — 96.4%.

About the Authors

Vasily A. Lastovka
National Medical Research Center for Children’s Health
Russian Federation
Moscow


Rustem F. Tepaev
National Medical Research Center for Children’s Health; I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Moscow


Olga B. Gordeeva
Pirogov Russian National Research Medical University; Research Institute of Pediatrics and Health Protection of Children, Central Clinical Hospital of the Russian Academy of Sciences
Russian Federation
Moscow


Anuar R. Bidzhiev
National Medical Research Center for Children’s Health; Research Institute of Pediatrics and Health Protection of Children, Central Clinical Hospital of the Russian Academy of Sciences
Russian Federation
Moscow


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Review

For citations:


Lastovka V.A., Tepaev R.F., Gordeeva O.B., Bidzhiev A.R. A prognostic model for thrombotic complications after pediatric cardiac surgery. Russian Pediatric Journal. 2020;1(4):11-17. (In Russ.) https://doi.org/10.15690/rpj.v1i4.2190

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