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Performance Assessment of Anti-Xa Assay-Based Heparin Dosing Protocol in Pediatric Patients on Extracorporeal Membrane Oxygenation. 基于抗xa测定的肝素给药方案在儿科体外膜氧合患者中的应用效果评价。
IF 0.9 Q3 Medicine Pub Date : 2023-11-01 Epub Date: 2023-09-01 DOI: 10.1177/21501351231178761
Abdulrazaq S Al-Jazairi, Eman M Shorog, Tarek M Owaidah, Hani Al Dalaty, Yasser A Alheriash, Rayd A Almehizia, Mamdouh D Alahmadi

Background: The use of extracorporeal membrane oxygenation (ECMO) in the postoperative cardiac critical care setting is evolving. Anticoagulation monitoring is among the most challenging aspects of pediatrics. However, there is no consensus on the optimal dosing and monitoring of unfractionated heparin in this setting. To address this, we developed an anti-Xa assay-based protocol derived from the best available clinical and anecdotal evidence of ECMO use and assessed its effectiveness in achieving the anti-Xa assay therapeutic target.

Methods: This prospective single-arm study was conducted in the pediatric carcardiac-surgery intensive care unit of a large tertiary hospital. We used two different anti-Xa assay intensity levels based on the patients' bleeding status.

Results: The median patient age was 7 (interquartile range [IQR]: 5-11.25) months, and the median weight was 5.7 (IQR: 3.8-13.82) kg. The median ECMO duration was 6 (IQR: 4.5-7.5) days. The bleeding protocol was used for most patients. Seventy percent achieved the anti-Xa assay therapeutic target during the study period (median: 75.5 h, IQR: 60.5-117.5 h). Hemorrhagic complications were reported in 40% of the patients, and thrombotic complications were reported in 25%. The median length of stay was 37 (IQR: 22-43) days, with a survival-to-discharge rate of 75%.

Conclusions: Despite a failure to achieve the anti-Xa assay target within the first ECMO days, most patients achieved the target by the median ECMO duration. Moreover, using two different anti-Xa assay levels reduced thrombotic complications.

背景:体外膜肺氧合(ECMO)在术后心脏重症监护环境中的应用正在发展。抗凝监测是儿科最具挑战性的方面之一。然而,在这种情况下,普通肝素的最佳给药和监测尚未达成共识。为了解决这一问题,我们根据ECMO使用的最佳临床和轶事证据,开发了一种基于抗Xa测定的方案,并评估了其在实现抗Xa检测治疗目标方面的有效性。方法:这项前瞻性单臂研究在一家大型三级医院的儿科心脏外科重症监护室进行。根据患者的出血情况,我们使用了两种不同的抗Xa检测强度水平。结果:患者年龄中位数为7个月(四分位间距[IQR]:5-11.25),体重中位数为5.7(IQR:3.8-13.82)kg。ECMO持续时间中位数为6(IQR:4.5-7.5)天。大多数患者采用出血方案。在研究期间,70%的患者达到了抗Xa检测的治疗目标(中位数:75.5 h、 IQR:60.5-117.5 h) 。40%的患者出现出血并发症,25%的患者出现血栓并发症。中位住院时间为37天(IQR:22-43),从存活到出院率为75%。此外,使用两种不同的抗Xa检测水平可以减少血栓并发症。
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引用次数: 0
Hospital Mortality and Adverse Events Following Repair of Congenital Heart Defects in Developing Countries. 发展中国家先天性心脏缺陷修复后的医院死亡率和不良事件
IF 0.9 Q3 Medicine Pub Date : 2023-11-01 Epub Date: 2023-06-29 DOI: 10.1177/21501351231176189
Brian P Bateson, Luqin Deng, Brittany Ange, Erle Austin, Robert Dabal, Taylor Broser, John Pennington, Sivalingam Sivakumar, Cheul Lee, Nguyen Ly Thinh Truong, Jeffery P Jacobs, Jorge Cervantes, James K Kirklin, James St Louis

Background: Mortality associated with the correction of congenital heart disease has decreased to approximately 2% in developed countries and major adverse events are uncommon. Outcomes in developing countries are less well defined. The World Database for Pediatric and Congenital Heart Surgery was utilized to compare mortality and adverse events in developed and developing countries.

Methods: A total of 16,040 primary procedures were identified over a two-year period. Centers that submitted procedures were dichotomized to low/middle income (LMI) and high income (HI) by the Gross National Income per capita categorization. Mortality was defined as any death following the primary procedure to discharge or 90 days inpatient. Multiple logistic regression models were utilized to identify independent predictors of mortality.

Results: Of the total number of procedures analyzed, 83% (n  =  13,294) were from LMI centers. Among all centers, the mean age at operation was 2.2 years, with 36% (n  =  5,743) less than six months; 85% (n  =  11,307) of procedures were STAT I/II for LMI centers compared with 77% (n = 2127) for HI centers (P < .0001). Overall mortality across the cohort was 2.27%. There was a statistical difference in mortality between HI centers (0.55%) versus LMI centers (2.64%) (P < .0001). After adjustment for other risk factors, the risk of death remained significantly higher in LMI centers (odds ratio: 2.36, 95% confidence interval: 1.707-3.27).

Conclusion: Although surgical expertise has increased across the globe, there remains a disparity with some outcomes associated with the correction of congenital heart disease between developing and developed countries. Further studies are needed to identify specific opportunities for improvement.

背景:在发达国家,与先天性心脏病矫正相关的死亡率已降至约2%,重大不良事件并不常见。发展中国家的成果没有得到很好的界定。世界儿科和先天性心脏外科数据库用于比较发达国家和发展中国家的死亡率和不良事件。方法:在两年的时间里,共确定了16040个主要程序。根据人均国民总收入分类,提交程序的中心被分为低/中等收入(LMI)和高收入(HI)。死亡率被定义为出院或住院90天后的任何死亡。采用多元逻辑回归模型来确定死亡率的独立预测因素。结果:在分析的手术总数中,83%(n  =  13294)来自LMI中心。在所有中心中,手术时的平均年龄为2.2岁,其中36%(n  =  5743)少于六个月;85%(n  =  11307例)LMI中心为STAT I/II,而HI中心为77%(n=2127)(P P 结论:尽管全球外科专业知识有所增加,但发展中国家和发达国家在先天性心脏病矫正方面的一些结果仍存在差异。需要进一步研究,以确定具体的改进机会。
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引用次数: 0
Hybrid Norwood for Hypoplastic Left Heart Syndrome With Rare Aortic Arch Anatomy. 混合诺伍德治疗左心发育不全综合征伴罕见主动脉弓解剖。
IF 0.9 Q3 Medicine Pub Date : 2023-11-01 Epub Date: 2023-05-23 DOI: 10.1177/21501351231176455
W Hampton Gray, Robert A Sorabella, C Mason Berry, Luz A Padilla, Mark A Law, Robert J Dabal

We describe the hybrid Norwood as first-stage palliation for a patient with hypoplastic left heart syndrome, right aortic arch, right descending aorta, bilateral ductus arteriosus, and left innominate artery arising from the left ductus.

我们将混合诺伍德描述为左心发育不良综合征、右主动脉弓、右降主动脉、双侧动脉导管和左导管引起的左无名动脉患者的第一阶段缓解。
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引用次数: 0
Invasive Coronary Assessment in a 9-Year-Old With Anomalous Aortic Origin of the Left Coronary Artery. 有创冠状动脉评估1例9岁左冠状动脉异常。
IF 0.9 Q3 Medicine Pub Date : 2023-11-01 Epub Date: 2023-09-10 DOI: 10.1177/21501351231185579
Thomas S Przybycien, Tam T Doan, Athar M Qureshi, Dana Reaves-O'Neal, Ziyad Binsalamah, Silvana Molossi

A previously healthy nine-year-old boy with anomalous aortic origin of the left coronary artery (AAOLCA) with high-risk anatomy demonstrated negative stress on magnetic resonance imaging. Invasive cardiac catheterization for intracoronary flow measurement was performed and demonstrated compromised coronary flow during pharmacologic stress and significant stenosis on angiography. The patient underwent surgical intervention with normalization of coronary flow upon postoperative evaluation. Invasive intracoronary flow determination with angiography under provocative stress is emerging as a critical data point for risk stratification and management decision-making in high-risk AAOLCA patients with negative noninvasive perfusion studies.

一名先前健康的九岁男孩患有左冠状动脉主动脉起源异常(AAOLCA),具有高风险解剖结构,在磁共振成像上表现出负应力。进行了有创心导管插入术测量冠状动脉内流量,并证明在药物应激期间冠状动脉流量受损,血管造影术显示严重狭窄。患者接受了手术干预,术后评估冠状动脉血流正常化。在无创灌注研究呈阴性的高危AAOLCA患者中,在挑衅性压力下通过血管造影术确定有创冠状动脉内血流正成为风险分层和管理决策的关键数据点。
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引用次数: 0
Review of: Pediatric Cardiac Surgery, Fifth Edition 回顾:小儿心脏外科,第五版
Q3 Medicine Pub Date : 2023-10-09 DOI: 10.1177/21501351231199730
S. Adil Husain
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引用次数: 0
Trileaflet Semilunar Valve Reconstruction: Acute Porcine in Vivo Evaluation. 三叶半月瓣重建术:急性猪体内评估
IF 0.9 Q3 Medicine Pub Date : 2023-07-01 Epub Date: 2023-04-11 DOI: 10.1177/21501351231166662
Lisa Carlson Hanse, Marcell Juan Tjørnild, Zarmiga Karunanithi, Johannes Høgfeldt Jedrzejczyk, Lejla Islamagič, Nynne Emilie Hummelshøj, Malene Enevoldsen, Germán Lugones, Mette Høj Lauridsen, Vibeke Elisabeth Hjortdal, Ignacio Lugones

Objective: The surgical treatment of malformed semilunar valves in congenital heart defects is challenging in terms of providing both longevity and the potential to grow with the recipient. We investigated a new surgical technique "Trileaflet Semilunar Valve Reconstruction" in an acute porcine model, a technique with geometrical properties that could remain sufficient and allow for some growth with the child. Methods: An acute 60-kg porcine model was used. With echocardiography, baseline pulmonary valvular geometry and hemodynamics were investigated. On cardiopulmonary bypass, the pulmonary leaflets were explanted, and the Trileaflet Semilunar Valve Reconstruction was performed with customized homograft-treated pericardial neo-leaflets. Off bypass, hemodynamics was reassessed. Results: Twelve animals were investigated. The neo-valves were found sufficient in ten animals and with minimal regurgitation in two animals. The neo-valve had a peak gradient of 3 ± 2 mm Hg with a peak velocity of 0.8 ± 0.2 m/s. The coaptation in the neo-valve had a mean increase of 4 ± 3 mm, P < .001. The neo-valve had a windmill shape in the echocardiographic short-axis view, and the neo-leaflets billowed at the annular plane in the long-axis view. Conclusions: In this acute porcine model, the neo-valve had no clinically significant regurgitation or stenosis. The neo-valve had an increased coaptation, a windmill shape, and leaflets that billowed at the annular plane. These geometric findings may allow for sustained sufficiency as the annular and pulmonary artery dimension increase with the child's growth. Further long-term studies should be performed to evaluate the efficacy and the growth potential.

目的:手术治疗先天性心脏缺陷中的畸形半月瓣是一项具有挑战性的工作,既要保证受术者的寿命,又要保证受术者的成长潜力。我们在急性猪模型中研究了一种新的外科技术 "三叶半月瓣重建术",这种技术的几何特性既能保证足够的寿命,又能使瓣膜随着受术者的成长而成长。方法:使用 60 公斤重的急性猪模型。通过超声心动图检查了肺动脉瓣的几何形状和血流动力学基线。在心肺旁路手术中,剥离肺动脉瓣叶,用定制的同种异体心包新瓣叶进行三叶半月瓣重建。脱离旁路后,重新评估血液动力学。结果对 12 只动物进行了调查。其中十只动物的新瓣膜功能正常,两只动物的新瓣膜反流极少。新瓣膜的峰值梯度为 3 ± 2 mm Hg,峰值速度为 0.8 ± 0.2 m/s。新瓣膜的合流平均增加了 4 ± 3 毫米,P 结论:在这个急性猪模型中,新瓣膜没有临床意义上的反流或狭窄。新瓣膜的吻合度增加,呈风车状,瓣叶在瓣环平面呈波浪状。随着患儿的成长,瓣环和肺动脉的尺寸也会增大,这些几何特征可能会使瓣膜持续充足。应进行进一步的长期研究,以评估其疗效和生长潜力。
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引用次数: 0
Combining Congenital Heart Surgical and Interventional Cardiology Outcome Data in a Single Database: The Development of a Patient-Centered Collaboration of the European Congenital Heart Surgeons Association (ECHSA) and the Association for European Paediatric and Congenital Cardiology (AEPC). 在单一数据库中合并先天性心脏病外科和介入心脏病学结果数据:欧洲先天性心脏病外科医生协会(ECHSA)和欧洲儿童与先天性心脏病协会(AEPC)以患者为中心的合作发展。
IF 0.9 Q3 Medicine Pub Date : 2023-07-01 DOI: 10.1177/21501351231168829
Jeffrey P Jacobs, Thomas Krasemann, Claudia Herbst, Zdzislaw Tobota, Bohdan Maruszewski, Jose Fragata, Tjark Ebels, Vladimiro L Vida, Ilkka Mattila, Andrzej Kansy, Boulos Asfour, Jürgen Hörer, Attilio A Lotto, M Sertaç Çiçek, Petru Liuba, Sven Dittrich, Massimo Chessa, Regina Bökenkamp, Gurleen Sharland, Katarina Hanséus, Nico A Blom, George E Sarris

The European Congenital Heart Surgeons Association (ECHSA) Congenital Database (CD) is the second largest clinical pediatric and congenital cardiac surgical database in the world and the largest in Europe, where various smaller national or regional databases exist. Despite the dramatic increase in interventional cardiology procedures over recent years, only scattered national or regional databases of such procedures exist in Europe. Most importantly, no congenital cardiac database exists in the world that seamlessly combines both surgical and interventional cardiology data on an international level; therefore, the outcomes of surgical and interventional procedures performed on the same or similar patients cannot easily be tracked, assessed, and analyzed. In order to fill this important gap in our capability to gather and analyze information on our common patients, ECHSA and The Association for European Paediatric and Congenital Cardiology (AEPC) have embarked on a collaborative effort to expand the ECHSA-CD with a new module designed to capture data about interventional cardiology procedures. The purpose of this manuscript is to describe the concept, the structure, and the function of the new AEPC Interventional Cardiology Part of the ECHSA-CD, as well as the potentially valuable synergies provided by the shared interventional and surgical analyses of outcomes of patients. The new AEPC Interventional Cardiology Part of the ECHSA-CD will allow centers to have access to robust surgical and transcatheter outcome data from their own center, as well as robust national and international aggregate outcome data for benchmarking. Each contributing center or department will have access to their own data, as well as aggregate data from the AEPC Interventional Cardiology Part of the ECHSA-CD. The new AEPC Interventional Cardiology Part of the ECHSA-CD will allow cardiology centers to have access to aggregate cardiology data, just as surgical centers already have access to aggregate surgical data. Comparison of surgical and catheter interventional outcomes could potentially strengthen decision processes. A study of the wealth of information collected in the database could potentially also contribute toward improved early and late survival, as well as enhanced quality of life of patients with pediatric and/or congenital heart disease treated with surgery and interventional cardiac catheterization across Europe and the world.

欧洲先天性心脏病外科医生协会(ECHSA)先天性数据库(CD)是全球第二大临床儿科和先天性心脏外科数据库,也是欧洲最大的数据库。尽管近年来介入心脏病学手术急剧增加,但欧洲仅有零星的国家或地区性此类手术数据库。最重要的是,世界上还没有一个先天性心脏病数据库能在国际层面上将外科手术和介入心脏病学数据完美地结合在一起;因此,对相同或相似患者进行的外科手术和介入手术的结果无法轻松地进行跟踪、评估和分析。为了填补我们在收集和分析普通患者信息方面的这一重要空白,欧洲儿童与先天性心脏病协会(ECHSA)和欧洲儿童与先天性心脏病协会(AEPC)已开始合作扩展 ECHSA-CD,并设计了一个新模块来捕捉有关介入心脏病学手术的数据。本手稿旨在描述 ECHSA-CD 中新的 AEPC 介入心脏病学部分的概念、结构和功能,以及通过共享患者的介入和手术结果分析可能产生的宝贵协同作用。ECHSA-CD 的新 AEPC 介入心脏病学部分将使各中心能够从自己的中心获得可靠的手术和经导管治疗结果数据,以及可靠的国内和国际综合结果数据,以便制定基准。每个作出贡献的中心或部门都可以访问自己的数据,以及来自 ECHSA-CD 的 AEPC 介入心脏病学部分的汇总数据。ECHSA-CD 的新 AEPC 介入心脏病学部分将允许心脏病学中心访问心脏病学汇总数据,就像外科中心已经可以访问外科汇总数据一样。手术和导管介入治疗结果的比较有可能加强决策过程。对数据库中收集的大量信息进行研究,还可能有助于改善早期和晚期存活率,并提高欧洲和全世界接受手术和介入性心导管治疗的儿童和/或先天性心脏病患者的生活质量。
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引用次数: 0
Physiologic Repair of Congenitally Corrected Transposition of the Great Arteries in a Criss-Cross Heart. 先天性矫正的大动脉横贯心的生理学修复
IF 0.9 Q3 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-31 DOI: 10.1177/21501351231174834
César Castillo-Romero, Julio C Cárdenas-González, Kenia K Espinosa-Guerra, Sergio A Patrón-Chi, Diego B Ortega-Zhindón, Jorge L Cervantes-Salazar

Congenitally corrected transposition of great arteries is an uncommon congenital heart disease characterized by discordance at both the atrioventricular and ventriculoarterial connections. A rare subgroup of patients with congenitally corrected transposition of the great arteries also has a criss-cross heart. The morphology of these patients represents a diagnostic challenge that requires critical analysis to perform a satisfactory surgical procedure. We present a case of a 12-year-old patient with the above mentioned anatomy who underwent physiologic repair.

先天性矫正性大动脉转位是一种不常见的先天性心脏病,其特点是房室和心室动脉连接处不协调。在先天性矫正性大动脉转位患者中,有一个罕见的亚群也有十字形心脏。这些患者的形态是一个诊断难题,需要进行严格的分析才能实施令人满意的手术。我们介绍了一例具有上述解剖结构的 12 岁患者,该患者接受了生理学修复。
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引用次数: 0
Atrial Appendage Aneurysms: Natural History and Outcomes. 心房阑尾动脉瘤:自然史和结果。
IF 0.9 Q3 Medicine Pub Date : 2023-07-01 Epub Date: 2023-03-27 DOI: 10.1177/21501351231162909
Michael P Penfold, Ikram-Ul Haq, Heidi M Connolly, Joseph A Dearani, Hartzell V Schaff, William R Miranda, Samuel J Asirvatham, Ammar M Killu, Arman Arghami, Elizabeth H Stephens

Background: Left (LAAA) and right atrial appendage aneurysms (RAAA) are rare entities, and their natural history, management, and long-term outcomes are not well studied.

Methods: This retrospective review includes all patients from 2000 to 2021 with atrial appendage aneurysms at our institution identified using an electronic search tool. LAAA and RAAA were confirmed using multimodality imaging and intraoperative findings.

Results: We identified 13 (87%) patients with LAAA and 2 (13%) with RAAA. At diagnosis, 11 (73%) were female, mean age was 51.4  ±  18.8 years, and ejection fraction 56.5  ±  13.1%. Three (20%) patients had congenital heart disease including 2 (13%) with atrioventricular septal defects and 1 (7%) with congenitally corrected transposition. LAAA/RAAA was diagnosed due to new-onset atrial fibrillation (AF) in 6 (40%) patients and embolic stroke in 2 (13%). Ten patients had preexisting AF diagnosed 2.9  ±  1.4 years earlier at a mean age of 50.2  ±  15.5 years. Thrombus within the aneurysm was identified in 2 (15%) LAAA patients. All patients were on anticoagulation and follow-up of the cohort from diagnosis was 7.1  ±  6.2 years. Eleven (73%) patients were surgically managed with 7 (64%) lesions excised, 1 (9%) stapled, and 3 (27%) ligated. Postoperative complications occurred in 2 (18%) patients with 1 (7%) developing tricuspid regurgitation and another with pericardial effusion and tamponade.

Conclusions: Atrial appendage aneurysm is a rare disease and nearly half of patients present with AF. Surgical treatment with concomitant AF ablation is a reasonable and safe management option.

背景:左心房(LAAA)和右心房阑尾动脉瘤(RAAA左心房(LAAA)和右心房阑尾动脉瘤(RAAA)是罕见的实体肿瘤,对其自然史、管理和长期预后的研究并不多:本回顾性研究包括本院 2000 年至 2021 年期间通过电子搜索工具发现的所有心房阑尾动脉瘤患者。通过多模态成像和术中发现证实了 LAAA 和 RAAA:我们发现了 13 名(87%)LAAA 患者和 2 名(13%)RAAA 患者。确诊时,11 名(73%)患者为女性,平均年龄(51.4±18.8)岁,射血分数(56.5±13.1%)。3名患者(20%)患有先天性心脏病,其中2人(13%)患有房室间隔缺损,1人(7%)患有先天性矫正性转位。6例(40%)患者因新发心房颤动(AF)而被诊断为LAAA/RAAA,2例(13%)因栓塞性中风而被诊断为LAAA/RAAA。10名患者在2.9±1.4年前就已诊断出心房颤动,平均年龄为50.2±15.5岁。2例(15%)LAAA患者的动脉瘤内发现了血栓。所有患者均接受了抗凝治疗,从确诊开始的随访时间为(7.1±6.2)年。11名(73%)患者接受了手术治疗,其中7名(64%)切除了病灶,1名(9%)进行了缝合,3名(27%)进行了结扎。2例(18%)患者出现术后并发症,其中1例(7%)出现三尖瓣反流,另1例出现心包积液和心包填塞:结论:心房阑尾动脉瘤是一种罕见疾病,近半数患者伴有房颤。结论:心房阑尾动脉瘤是一种罕见疾病,近半数患者伴有房颤,手术治疗同时进行房颤消融是一种合理而安全的治疗方案。
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引用次数: 0
Activated Prothrombin Complex Concentrate in Pediatric Cardiac Patients, Our Early Experience. 活化凝血酶原复合物浓缩物在小儿心脏病患者中的应用,我们的早期经验。
IF 0.9 Q3 Medicine Pub Date : 2023-07-01 Epub Date: 2023-06-04 DOI: 10.1177/21501351231174828
Elena Ashikhmina Swan, Nathan J Brinkman, Brian D Lahr, Michael E Nemergut, Joseph A Dearani, Elizabeth H Stephens

Background: Pediatric cardiac surgery is associated with abnormal coagulation, bleeding, and nearly ubiquitous transfusions. With the popularization of patient blood management, attempts are being made to decrease liberal transfusions by administering prothrombin complex concentrates (PCCs). The safety and efficacy of PCCs in adult cardiac surgery has been studied extensively, but only few reports address this in children. We performed an observational study focused on transfusion requirements after off-label use of activated PCC Factor Eight Inhibitor Bypassing Activity (FEIBA) as an adjunct to post-cardiopulmonary bypass (CPB) hemostatic protocol.

Methods: We reviewed the medical records of children ≤15 kg undergoing cardiac operations with CPB between May 2018 and March 2022. A propensity score (PS) analysis was performed to identify matched pairs of patients who did and did not receive FEIBA.

Results: Out of 210 patients who met the inclusion criteria, 44 patients received FEIBA. Propensity score-based analysis identified 40 matched pairs of patients with similar baseline characteristics. There was no statistically significant difference in the primary outcome-the volume of transfusion after CPB, which included all allogeneic blood products and salvaged washed red cells administered after protamine. Specifically, FEIBA patients were transfused 28 (22-34) mL/kg and controls were transfused 22 (11-49) mL/kg, P = .989. Upon arrival to ICU, the FEIBA group averaged an 8% lower international normalized ratio, compared with the controls (P = .009) and a 1.08 g/dL higher hemoglobin (P = .050). Neither difference remained significant on POD 1.

Conclusions: In this exploratory study, we found no change in transfusion requirements after CPB despite FEIBA administration.

背景:小儿心脏手术与凝血异常、出血和几乎无处不在的输血有关。随着患者血液管理的普及,人们正试图通过使用凝血酶原复合物浓缩物(PCCs)来减少大量输血。有关凝血酶原复合物浓缩物在成人心脏手术中的安全性和有效性的研究已经非常广泛,但有关儿童心脏手术的报道却寥寥无几。我们进行了一项观察性研究,重点关注标签外使用活化的 PCC 八因子抑制剂旁路活性(FEIBA)作为心肺旁路术(CPB)后止血方案的辅助治疗后的输血需求:我们回顾了2018年5月至2022年3月期间接受CPB心脏手术的体重≤15公斤儿童的病历。我们进行了倾向评分(PS)分析,以确定接受和未接受 FEIBA 的配对患者:在符合纳入标准的 210 名患者中,44 名患者接受了 FEIBA。基于倾向评分的分析确定了 40 对基线特征相似的配对患者。CPB 后的输血量(包括所有异体血制品和原位胺后输注的抢救性洗涤红细胞)与主要结果无统计学差异。具体来说,FEIBA 患者的输血量为 28 (22-34) mL/kg,对照组为 22 (11-49) mL/kg,P = 0.989。抵达重症监护室后,FEIBA 组患者的国际标准化比率平均比对照组低 8%(P = .009),血红蛋白平均比对照组高 1.08 g/dL(P = .050)。这两项差异在 POD 1 时仍不明显:在这项探索性研究中,我们发现尽管使用了 FEIBA,但 CPB 后的输血需求没有变化。
{"title":"Activated Prothrombin Complex Concentrate in Pediatric Cardiac Patients, Our Early Experience.","authors":"Elena Ashikhmina Swan, Nathan J Brinkman, Brian D Lahr, Michael E Nemergut, Joseph A Dearani, Elizabeth H Stephens","doi":"10.1177/21501351231174828","DOIUrl":"10.1177/21501351231174828","url":null,"abstract":"<p><strong>Background: </strong>Pediatric cardiac surgery is associated with abnormal coagulation, bleeding, and nearly ubiquitous transfusions. With the popularization of patient blood management, attempts are being made to decrease liberal transfusions by administering prothrombin complex concentrates (PCCs). The safety and efficacy of PCCs in adult cardiac surgery has been studied extensively, but only few reports address this in children. We performed an observational study focused on transfusion requirements after off-label use of activated PCC Factor Eight Inhibitor Bypassing Activity (FEIBA) as an adjunct to post-cardiopulmonary bypass (CPB) hemostatic protocol.</p><p><strong>Methods: </strong>We reviewed the medical records of children ≤15 kg undergoing cardiac operations with CPB between May 2018 and March 2022. A propensity score (PS) analysis was performed to identify matched pairs of patients who did and did not receive FEIBA.</p><p><strong>Results: </strong>Out of 210 patients who met the inclusion criteria, 44 patients received FEIBA. Propensity score-based analysis identified 40 matched pairs of patients with similar baseline characteristics. There was no statistically significant difference in the primary outcome-the volume of transfusion after CPB, which included all allogeneic blood products and salvaged washed red cells administered after protamine. Specifically, FEIBA patients were transfused 28 (22-34) mL/kg and controls were transfused 22 (11-49) mL/kg, <i>P</i> = .989. Upon arrival to ICU, the FEIBA group averaged an 8% lower international normalized ratio, compared with the controls (<i>P</i> = .009) and a 1.08 g/dL higher hemoglobin (<i>P</i> = .050). Neither difference remained significant on POD 1.</p><p><strong>Conclusions: </strong>In this exploratory study, we found no change in transfusion requirements after CPB despite FEIBA administration.</p>","PeriodicalId":23974,"journal":{"name":"World Journal for Pediatric and Congenital Heart Surgery","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9792795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
World Journal for Pediatric and Congenital Heart Surgery
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