Morphology-Based Risk Analysis of Catheter-related Thrombus After Pediatric Cardiac Surgery

Abstract

Background: Understanding the development of central venous catheter-related thrombus (CVCRT) is vital for the prevention of adverse events caused by thrombi after cardiac surgery in children. However, the risks associated with CVCRT remain controversial. This study analyzed the risk factors of CVCRT based on a detailed evaluation of its morphometric features and severity. Methods: Patients aged <15 years who underwent catheter insertion into the internal jugular vein for cardiac surgery were included, and those receiving extracorporeal membrane oxygenation were excluded. The clinical data of the eligible patients, including the ultrasound CVCRT images and the ratio of the catheter occupying the internal jugular vein area (C/V ratio) by reassuming the images, were consistently collected. Logistic regression analysis using clinical factors was performed for the 2 groups divided according to morphologic severity. Results: Forty-seven patients were included in the study. CVCRT developed in 38 patients. Five graded types, ranging from wall-localized small thrombi to complete occlusion of the vein, were detected, and those who developed sheath-like thrombus were classified in to the severe group. Patients in the severe group were significantly younger and had higher C/V ratios. There were no significant differences in the surgical procedure, its difficulty, or postoperative severity score. Logistic regression analysis revealed the C/V ratio as the sole significant risk factor (odds ratio, 1.120; 95% CI, 1.01-1.24; P = .036). Conclusions: Our findings show the clinical implications of thrombus evaluation and morphologic classification to properly assess the risk factors of CVCRT in children with heart disease.