Evaluation of Coagulation Testing in Patients Undergoing Cardiac Surgery

Neonates, children with single ventricle congenital heart disease, and those undergoing
multiple complex cardiac surgeries are at high risk of increased perioperative blood loss,
and blood product transfusions. In addition, some of these patients will present an increased
risk of postoperative thromboembolic complications. For a long time, bleeding management has
been based on the empiric administration of different blood products (e.g. platelet
concentrates, cryoprecipitates, and/or activated factor VII), topical hemostatic agents, and
surgical manipulation. Recently, the use of viscoelastic tests (e.g. thromboelastography
(TEG) or thromboelastometry (ROTEM)) increased, and allowed a better assessment of
perioperative coagulopathy, and a more 'rational' treatment of bleeding. While TEG and ROTEM
record the viscoelastic properties of whole blood by measuring mechanical impedance and
related changes during clot formation, T2MR, a miniaturized, magnetic resonance-based
diagnostic platform, measures how water molecules react in the presence of magnetic fields to
evaluate a broad range of hemostasis measurements. In this study, we will prospectively
collect demographic data, surgical characteristics, the amount of perioperative bleeding and
blood product transfusion, results of laboratory assays, and postoperative outcomes (30-day
follow-up or until discharge), with the aim to assess our current practice, and develop an
algorithm-based approach for the administration of targeted blood product and pro-coagulant
therapies. Our goals are: the reduction of blood product utilization, the reduction of the
incidence of massive bleeding and postoperative thrombosis.