Risk factors associated with platelet transfusions in patients undergoing atrial septal defect and ventricular septal defect repair

Suwanee, GA

Introduction:

Pediatric patients often require platelet transfusions after cardiac surgery to treat cardiopulmonary bypass (CPB) induced platelet dysfunction.1 While platelet transfusions are often necessary to treat post-CPB coagulopathy, they have the highest rate of adverse events of blood component therapy in pediatric patients.2 Therefore, we sought to identify perioperative risk factors for platelet transfusions in pediatric patients undergoing atrial septal (ASD) and ventricular septal defect (VSD) repairs in order to identify modifiable factors that may aid in decreasing unnecessary transfusions at our institution.

Methods:

In this retrospective study, we analyzed the Society of Thoracic Surgeon’s Congenital Heart Surgery Database of children between the ages of 1- and 21-years undergoing ASD and VSD repair at our institution from 2017 to 2021. Demographics, intraoperative data, and laboratory data were analyzed with univariate and multivariable logistic regression to identify predictors of perioperative platelet transfusion.

Results:

Forty nine percent (105/214) of our pediatric patients received platelets transfusions. Patients who received platelets had a higher platelet and fibrinogen levels on ICU arrival. Only 2/105 patients received platelets in the ICU only. There were no significant differences in bleeding complications between groups. On univariate analyses, we identified the follow risk factors for platelet transfusion: younger age; smaller; lower preoperative hemoglobin levels, VSD repair; longer procedure time (Table 1). On multivariable logistic regression analysis, lower weight and preoperative hemoglobin levels were independently associated with increased platelet transfusions (Table 2).

Discussion:

Consistent with other studies evaluating predictors of transfusions in pediatric patients undergoing cardiac surgery, smaller patients and preoperative anemia increase the risk of platelet transfusion. This is not surprising given that lower weight and anemia make one more susceptible to the effects of hemodilution by CBP. These data suggest that optimizing perioperative hemostasis and reducing hemodilution on bypass may decrease overall transfusions in this population. The results will provide a foundation to develop appropriate guidance to minimize unnecessary platelet transfusions in this population.

Conclusion:

Developing perioperative protocols that utilize viscoelastic testing and reduce hemodilution on bypass may help reduce platelet transfusions and improve outcomes in patients undergoing ASD/VSD repairs.