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Post-operative blood loss is higher among African American neonates undergoing open-heart surgery with cardiopulmonary bypass for CHD

Published online by Cambridge University Press:  06 December 2019

Vyas M. Kartha Open the ORCID record for Vyas M. Kartha [Opens in a new window] ,
Mohamed Rehman ,
Anh Thy H. Nguyen ,
Ernest Amankwah ,
Erica M.S. Sibinga ,
Neil A. Goldenberg  and
Jeffrey P. Jacobs
Vyas M. Kartha*
Affiliation:
Department of Anesthesiology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA Johns Hopkins All Children’s Heart Institute, Saint Petersburg, FL, USA
Mohamed Rehman
Affiliation:
Department of Anesthesiology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
Anh Thy H. Nguyen
Affiliation:
Health Informatics, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
Ernest Amankwah
Affiliation:
Health Informatics, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA Johns Hopkins All Children’s Cancer and Blood Disorders Institute, Saint Petersburg, FL, USA
Erica M.S. Sibinga
Affiliation:
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Neil A. Goldenberg
Affiliation:
Johns Hopkins All Children’s Cancer and Blood Disorders Institute, Saint Petersburg, FL, USA Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA Johns Hopkins All Children’s Clinical and Translational Research Organization, All Children’s Research Institute, Saint Petersburg, FL, USA Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
Jeffrey P. Jacobs
Affiliation:
Johns Hopkins All Children’s Heart Institute, Saint Petersburg, FL, USA Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
*
Author for correspondence: Dr V. Kartha, Department of Anesthesiology, Johns Hopkins All Children’s Hospital, 501 6th Avenue South, Saint Petersburg, FL 33701, USA. Tel: (727) 767-3583; Fax: (727) 767-8429. E-mail: [email protected]
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Abstract

Background:

Neonates are at high risk of bleeding after open-heart surgery. We sought to determine pre-operative and intra-operative risk factors for increased bleeding after neonatal open-heart surgery with cardiopulmonary bypass.

Methods:

We conducted a retrospective cohort study of neonates (0–30 days old) who underwent open-heart surgery with cardiopulmonary bypass from January, 2009, to March, 2013. Cardiac diagnosis; demographic and surgical data; and blood products, haemostatic agents, and anti-thrombotic agents administered before, during, and within 24 hours after surgery were abstracted from the electronic health record and anaesthesia records. The outcome of interest was chest tube output (in ml/kg body weight) within 24 hours. Relationships between chest tube output and putative associated factors were evaluated by unadjusted and adjusted linear regression.

Results:

The cohort consisted of 107 neonates, of whom 79% had a Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Mortality Category of 4 or 5. Median chest tube output was 37 ml/kg (range 9–655 ml/kg). Age, African-American race, and longer durations of surgery and cardiopulmonary bypass each had statistically significant associations with increased chest tube output in unadjusted analyses. In multivariable analysis, African-American race retained an independent, statistically significant association with increased chest tube output; the geometric mean of chest tube output among African-American neonates was 71% higher than that of Caucasians (95% confidence interval, 29–125%; p = 0.001).

Conclusion:

Among neonates with CHD undergoing open-heart surgery with cardiopulmonary bypass, African-American race is independently associated with greater chest tube output over the first 24 hours post-operatively.

Keywords

BleedingCHDneonateopen-heart surgerycardiopulmonary bypass
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 1 , January 2020 , pp. 74 - 81
Copyright
© Cambridge University Press 2019

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Footnotes

*

In neonates undergoing open-heart surgery, numerous factors influence post-operative blood loss. Previous studies have identified prematurity, lower weight, longer cardiopulmonary bypass time, longer aortic cross-clamp time, and longer regional perfusion time or circulatory arrest time to be potentially prognostic.

In this single-centre retrospective cohort study of over 100 neonates undergoing open-heart surgery with cardiopulmonary bypass, after adjustment for other factors, African American race was independently associated with increased post-operative blood loss.

References

van der Linde, D, Konings, EEM, Slager, MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011; 58: 2241–2247.CrossRefGoogle ScholarPubMed
Rinder, CS, Gaal, D, Student, LA, Smith, BR.Platelet-leukocyte activation and modulation of adhesion receptors in pediatric patients with congenital heart disease undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1994; 107: 280–288.CrossRefGoogle ScholarPubMed
Brown, AC, Hannan, RT, Timmins, LH, Fernandez, JD, Barker, TH, Guzzetta, NA.Fibrin network changes in neonates after cardiopulmonary bypass. Anesthesiology. 2016; 124: 1021–1031.CrossRefGoogle ScholarPubMed
Ziyaeifard, M, Alizadehasl, A, Massoumi, G.Modified ultrafiltration during cardiopulmonary bypass and postoperative course of pediatric cardiac surgery. Res Cardiovasc Med. 2014; 3: e17830.Google ScholarPubMed
Szekely, A, Cserep, Z, Sapi, E, et al. Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations. Ann Thorac Surg. 2009; 87: 187–197.CrossRefGoogle ScholarPubMed
Kartha, VM, Jacobs, JP, Vener, DF, et al. National benchmarks for proportions of patients receiving blood transfusions during pediatric and congenital heart surgery: an analysis of the STS Congenital Heart Surgery Database. Ann Thorac Surg. 2018; 106: 1197–1203.CrossRefGoogle ScholarPubMed
Ignjatovic, V, Chandramouli, A, Than, J, et al. Plasmin generation and fibrinolysis in pediatric patients undergoing cardiopulmonary bypass surgery. Pediatr Cardiol. 2012; 33: 280–285.CrossRefGoogle ScholarPubMed
Philipp, CS, Dilley, A, Miller, CH, et al. Platelet functional defects in women with unexplained menorrhagia. J Thromb Haemost. 2003; 1: 477–484.CrossRefGoogle ScholarPubMed
Faraday, N, Yanek, LR, Yang, XP, et al. Identification of a specific intronic PEAR1 gene variant associated with greater platelet aggregability and protein expression. Blood. 2011; 118: 3367–3375.CrossRefGoogle ScholarPubMed
Di Paola, J, Jugessur, A, Goldman, T, et al. Platelet glycoprotein I(b)alpha and integrin alpha2 beta1 polymorphisms: gene frequencies and linkage disequilibrium in a population diversity panel. J Thromb Haemost. 2005; 3: 1511–1521.CrossRefGoogle Scholar
Lam, SK, Pan, IW, Harris, DA, Sayama, CM, Luerssen, TG, Jea, A.Patient-, procedure-, and hospital-related risk factors of allogeneic and autologous blood transfusion in pediatric spinal fusion surgery in the United States. Spine (Phila Pa 1976). 2015; 40: 560–569.CrossRefGoogle ScholarPubMed
Maher, KM, Owusu-Akyaw, K, Zhou, J, et al. Analysis of the impact of race on blood transfusion in pediatric scoliosis surgery. Paediatr Anaesth. 2018; 28: 352–360.CrossRefGoogle ScholarPubMed
Song, J, Chen, F, Campos, M, Bolgiano, D, et al. Quantitative Infludenc of ABO Blood Groups on Factor VIII, and Its Ratio to von Willebrand Factor, Novel Observations from an ARIC Study of 11,673 Subjects. PLoS ONE, 2015: 10: 1–11.Google ScholarPubMed
Qian, F, Eaton, MP, Lustik, SJ, et al. Racial disparities in the use of blood transfusion in major surgery. BMC Health Serv Res. 2014; 14: 121.CrossRefGoogle ScholarPubMed
Guzzetta, NA, Russell, IA, Williams, GD.Review of the off-label use of recombinant activated factor VII in pediatric cardiac surgery patients. Anesth Analg. 2012; 115: 364–378.CrossRefGoogle ScholarPubMed
Guzzetta, NA, Allen, NN, Wilson, EC, Foster, GS, Ehrlich, AC, Miller, BE.Excessive postoperative bleeding and outcomes in neonates undergoing cardiopulmonary bypass. Anesth Analg. 2015; 120: 405–410.CrossRefGoogle ScholarPubMed
Savan, V, Willems, A, Faraoni, D, Van der Linden, P.Multivariate model for predicting postoperative blood loss in children undergoing cardiac surgery: a preliminary study. Br J Anaesth. 2014; 112: 708–714.CrossRefGoogle ScholarPubMed
Petaja, J, Lundstrom, U, Leijala, M, Peltola, K, Siimes, MA.Bleeding and use of blood products after heart operations in infants. J Thorac Cardiovasc Surg. 1995; 109: 524–529.CrossRefGoogle ScholarPubMed
Williams, GD, Bratton, SL, Ramamoorthy, C.Factors associated with blood loss and blood product transfusions: a multivariate analysis in children after open-heart surgery. Anesth Analg. 1999; 89: 57–64.Google ScholarPubMed
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