Risk Factors Associated With Central Venous Catheter-Associated Deep Vein Thrombosis After Pediatric Congenital Heart Surgery: An Analysis of the Pediatric Cardiac Critical Care Consortium Registry

Abstract

Objective: Infants and children undergoing cardiac surgery are one of the highest-risk groups for thrombosis and its sequelae. We sought to define the current rate of and risk factors for postoperative central venous catheter (CVC)-associated deep vein thrombosis (CA-DVT) using the Pediatric Cardiac Critical Care Consortium (PC⁴) dataset. Design: Retrospective review of PC⁴ database from February 2019 to February 2022. Patients: Children <18 years of age admitted for a surgical encounter who had a CVC placed. Results: Included were 33,491 patient encounters, of whom 37.6% (12,582/33,491) were infants (<12 months of age). The overall CA-DVT rate was 2.5% (844/33,491), which varied widely among centers (0-11%). Multivariable analysis showed increased risk of CA-DVT with increasing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category (STAT 2 HR 1.8, CI [1.26-2.65]; STAT 3 HR 2.2, CI [1.56-3.39]; STAT 4 HR 2.1, CI [1.55-2.93]; STAT 5 HR 2.5, CI [1.69-3.82]), (P < .001 for all), low cardiac output syndrome (HR 1.5, CI [1.25-1.91]), P < .001, and postoperative arrhythmia (HR 1.23, CI [1.03-1.47]) P = .024). Patients with CA-DVT were less likely to have an internal jugular vein catheter or intracardiac line and more likely to have an umbilical venous catheter, femoral vein CVC, peripherally inserted CVC, and/or multiple CVCs. Conclusions: CA-DVT remains an important postoperative complication after pediatric cardiac surgery, with greatest risk of occurrence in the younger, smaller, more surgically complex by STAT category, and hemodynamically vulnerable patients. These risk factors must be considered when developing paradigms for CVC placement, thromboprophylaxis, and diagnosis/treatment of CA-DVT in the future.