Angiojet rheolytic thrombectomy in infants following cardiac surgery.

OBJECTIVES: To present our experience with the Angiojet thrombectomy system for percutaneous thrombectomy in infants following cardiac surgery. BACKGROUND: Arterial and venous thrombosis after pediatric cardiac surgery is life threatening, particularly in infants. The best method for treating these patients has not been determined. Angiojet rheolytic thrombectomy (Possis Medical, Minneapolis, MN) is a percutaneous method of thrombus removal with proven safety and efficacy in adults. METHODS: We reviewed the medical records and angiograms of all procedures in which Angiojet thrombectomy was used in infants following cardiac surgery at our institution during the years 2005 through 2007. RESULTS: Ten procedures were performed in eight infants. The procedure was performed a mean of 23 days from surgery. The mean age was 74 days with a mean weight of 4.3 kg. All patients had life or limb threatening thrombosis. Indications for thrombectomy included severe cyanosis, chronic pleural effusions secondary to extensive venous thrombosis, and acute iliac artery thrombosis. Thrombus was evacuated from pulmonary arteries in four patients, systemic veins in two patients, a surgical aorto-pulmonary shunt in two patients, and an iliac artery in one patient. Balloon angioplasty following thrombectomy was performed in eight procedures (80%), and stents were placed in addition to angioplasty in two procedures. All patients had significant improvement in flow across the affected area. There was one major complication and three minor complications with no procedural-related deaths. Survival to discharge from the hospital was 62.5%. CONCLUSION: Angiojet thrombectomy is an effective treatment for life-threatening postoperative thrombosis in infants following cardiac surgery.

Duke Scholars

Author Gregory Allan Fleming Pediatrics, Cardiology