Rogelyn F Tapuro-Olais
Philippine Heart Center, Philippines
Dr. Rogelyn F. Tapuro-Olais has completed her medical degree at Saint Louis University and internship at Philippine General Hospital. She had her pediatric residency training at Saint Louis University Hospital where she won first place in the Annual Residents’ Research Contest in 2009. She completed her 3-year fellowship training in Pediatric Cardiology at the Philippine Heart Center. Presently, she is a clinical research fellow in echocardiography at the same institution.
Background: Excessive bleeding after cardiopulmonary bypass (CPB) continues to be an important cause of morbidity and mortality for both adult and pediatric population.
Objectives: 1) To determine the incidence of postoperative bleeding among children with cyanotic and acyanotic heart disease undergoing CPB with early and routine determination of PT and PTT; 2) To determine if there is significant difference in bleeding outcomes in early versus routine determination of PT and PTT levels among children with cyanotic and acyanotic heart disease undergoing CPB; 3) To determine if there is significant difference in the number of blood products transfused in early versus routine determination of PT and aPTT levels among children with cyanotic and acyanotic heart disease Methods: Double-blinded randomized controlled trial was done. One hundred twelve children who underwent open heart surgery from February 2012 to December 2012 at Philippine Heart Center were included. Fifty-six had cyanotic heart disease and 56 had acyanotic heart disease. Each group was subdivided into group A and group B. Group A had early determination of PT and aPTT (blood sample taken after CPB) while group B had routine determination of PT and aPTT (blood sample taken after surgery). Chest tube drainage was recorded for 24 hours and this was the measure for postoperative bleeding. Volume of blood products transfused was also recorded. Chi-square and T tests were used for statistical analysis. Results: The study showed 32.1% incidence of significant postoperative bleeding among patients with cyanotic CHD with group A while 39.3% with group B (p value=0.00). And the volume of PRBC transfused among the cyanotic subjects in group B is higher at 14.54 cc/kg compared to group A at 9.89 cc/kg (p value=0.05). While among the acyanotic patients, there was no significant difference in the incidence of significant postoperative bleeding and volume of transfused blood products.
Conclusion: There is higher incidence of significant postoperative bleeding in cyanotic patients, group B than group A. Also, the volume of PRBC transfused among cyanotic patients in group B is larger compared to group A. Whereas, among acyanotic patients, there is no significant difference in the incidence of significant postoperative bleeding and volume of transfused blood products between group A and B.