PB0610 - Rate of, and Risk Factors for, Thromboembolism in Pediatric Patients with Surgical Congenital Heart Disease Undergoing Cardiac Surgery: A Case-control Study

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Amy Kiskaddon, PharmD, MBA

Assistant Professor of Pediatrics
Johns Hopkins University, Florida, United States

Co-Author(s)

AS

Arabela Stock

Pediatric Cardiac Intensivist
Johns Hopkins All Children's Hospital
St. Petersburg, Florida, United States
SF

Shannon Frank

RN Clinical Database Administrator
Johns Hopkins All Children's Hospital
St. Petersburg, Florida, United States
HT

Heather Tinling

RN Clinical Database Administrator
Johns Hopkins All Children's Hospital
St. Petersburg, Florida, United States
JQ

James Quintessenza

Professor and Chief of Cardiovascular Surgery
Johns Hopkins All Children's Hospital
St. Petersburg, Florida, United States
Vera Ignjatovic, PhD, MBA

Professor of Pediatrics
Johns Hopkins All Children's Institute for Clinical and Translational Research; Department of Pediatrics, School of Medicine, Johns Hopkins University, United States
St Petersburg, Florida, United States
Neil Goldenberg, MD,PhD

Departments of Pediatrics and Medicine
Johns Hopkins University School of Medicine, Baltimore, MD; Clinical and Data Coordinating Center for Pediatric Multicenter Studies, Johns Hopkins All Children’s Institute for Clinical and Translational Research, St. Petersburg, FL
Saint Petersburg, Florida, United States

Background: Thromboembolism (TE) is a common complication in pediatric congenital heart disease (CHD). Data describing the rate, timing and factors associated with TE in pediatric CHD are limited.

Aims: To describe the rate of, and risk factors for, TE before and after cardiac surgery in pediatric CHD. Secondary aim was to determine the rate of recurrent TE.

Methods: IRB-approved, single-center retrospective study from October 2020 - November 2023. Patients < 18 years of age with radiologically confirmed TE either 12 months before or after cardiac surgery were compared with randomly selected patients without TE (1:2 ratio). Data included age, cardiac catheterization, CHD diagnosis/surgery type, postoperative complications, length of stay, mortality, development of TE, and details regarding timing/location of incident/recurrent TEs. Descriptive and inferential statistics were utilized.

Results: Of 302 patients, 45 (15%) developed a TE: 16 (35.6%) developed TE before and 29 (64.4%) after cardiac surgery. TE types were: 11 (24.4%) arterial, 32 (71.1%) venous, and 2 (4.5%) intracardiac. In univariate analyses, age < 12 months (p=0.01), single-ventricle (p=0.03), intra-cardiac lines (p=0.02), cardiac-catheterization (p <.001), mechanical ventilation (p <.001), infection (p= <.001), and mechanical circulatory support (p=.003) were associated with TE; specifically, age < 30 days (p <.001), mechanical ventilation (p <.001), and infection (p=.03) were associated with TE before surgery, while single-ventricle (p=0.003), central-venous/intracardiac lines (p=0.04), cardiac-catheterization (p <.001), mechanical ventilation (p <.001), infection (p=.03) and post-op LOS (p <.001) were associated with TE after surgery. Patients with TE had a longer median (IQR) post-op LOS 20 [8-48] vs. 6 [4-12] days, p<.001, and higher mortality (11% vs. 2.2%, p=0.04). Among those who developed a TE, recurrent TE occurred in 10 (22.2%).

Conclusion(s): Among pediatric CHD patients undergoing cardiac surgery, TE before, after, and its recurrence are high. Putative risk factors for development of TE have been identified and should be further evaluated in multivariable models via future collaborative studies