Research

Children undergoing cardiac surgery for complex cardiac defects show imbalance between pro- and anti-thrombotic activity

Ruth Heying¹ , Wim van Oeveren² , Stefanie Wilhelm¹ , Katharina Schumacher¹ , Ralph G Grabitz¹ , Bruno J Messmer³ and Marie-Christine Seghaye¹

¹Department of Pediatric Cardiology, University Hospital, RWTH-Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany

²Department of BioMedical Engineering, University of Groningen, A. Deusinglaan1, 9713 AV Groningen, The Netherlands

³Department of Cardiothoracic and Vascular Surgery, University Hospital, RWTH-Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany

author email corresponding author email

Critical Care 2006, 10:R165doi:10.1186/cc5108

Published:	24 November 2006

Abstract

Introduction

Cardiac surgery with cardiopulmonary bypass (CPB) is associated with the activation of inflammatory mediators that possess prothrombotic activity and could cause postoperative haemostatic disorders. This study was conducted to investigate the effect of cardiac surgery on prothrombotic activity in children undergoing cardiac surgery for complex cardiac defects.

Methods

Eighteen children (ages 3 to 163 months) undergoing univentricular palliation with total cavopulmonary connection (TCPC) (n = 10) or a biventricular repair (n = 8) for complex cardiac defects were studied. Prothrombotic activity was evaluated by measuring plasma levels of prothrombin fragment 1+2 (F1+2), thromboxane B₂ (TxB2), and monocyte chemoattractant protein-1 (MCP-1). Anti-thrombotic activity was evaluated by measuring levels of tissue factor pathway inhibitor (TFPI) before, during, and after cardiac surgery.

Results

In all patients, cardiac surgery was associated with a significant but transient increase of F1+2, TxB2, TFPI, and MCP-1. Maximal values of F1+2, TxB2, and MCP-1 were found at the end of CPB. In contrast, maximal levels of TFPI were observed at the beginning of CPB. Concentrations of F1+2 at the end of CPB correlated negatively with the minimal oesophageal temperature during CPB. Markers of prothrombotic activity returned to preoperative values from the first postoperative day on. Early postoperative TFPI levels were significantly lower and TxB2 levels significantly higher in patients with TCPC than in those with biventricular repair. Thromboembolic events were not observed.

Conclusion

Our data suggest that children with complex cardiac defects undergoing cardiac surgery show profound but transient imbalance between pro- and anti-thrombotic activity, which could lead to thromboembolic complications. These alterations are more important after TCPC than after biventricular repair but seem to be determined mainly by low antithrombin III.