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J Thorac Cardiovasc Surg 1998;116:286-293
© 1998 Mosby, Inc.

Surgery for Congenital Heart Disease

HEPARIN AS A RISK FACTOR FOR PERIGRAFT SEROMA COMPLICATING THE MODIFIED BLALOCK-TAUSSIG SHUNT

From the Departments of Pediatrics, Division of Pediatric Cardiology,^a Cardiothoracic Surgery,^b and Epidemiology and Biostatistics,^c Sophia Children's Hospital, University Hospital Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands.

Received for publication May 21, 1997. Revisions requested August 4, 1997; revisions received March 4, 1998. Accepted for publication April 13, 1998. Address for reprints: R. M. F. Berger, MD, Division of Pediatric Cardiology, Sophia Children's Hospital, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands; PO Box 2060, 3000 CB Rotterdam, The Netherlands.

Objective: The purpose of this study was to determine the risk factors associated with the occurrence of perigraft seromas complicating systemic-to-pulmonary polytetrafluoroethylene grafts.
Methods: Clinical and perioperative variables were reexamined, blinded for the outcome variable perigraft seroma, in 60 patients undergoing 67 consecutive graft procedures in a 3.5-year period.
Results: Eight cases of perigraft seroma were diagnosed in six patients. Univariate analysis revealed age (p = 0.02), a diagnosis of pulmonary atresia with ventricular septal defect and systemic–pulmonary collaterals (p = 0.001), reimplantation of collaterals during the procedure (p < 0.001), and intravenous heparin administered after operation (p < 0.0001) as risk factors for symptomatic perigraft seroma. Multivariable analysis defined heparin as the only significant factor associated with symptomatic perigraft seroma. Consolidation of the upper lobe on chest radiograph, ipsilateral to the shunt, directly after operation (p = 0.01), but especially 8 to 10 days after operation (p < 0.0001), or the need for prolonged drainage of pleural fluid (p < 0.0001) were correlated with the occurrence of perigraft seroma. Perigraft seroma led to four early rethoracotomies in three patients and to accelerated corrective surgery in three cases. Consolidation and absent perfusion of lung segments persisted in two patients.
Conclusions: Our data suggest that the use of heparin leads to an increased risk of perigraft seroma, complicating systemic–pulmonary polytetrafluoroethylene grafts. Prolonged pleural drainage and/or postoperative consolidation of the upper lobe indicate the development of symptomatic perigraft seroma. Treatment is controversial and results are unpredictable. Expectative management seems to be justified so long as permitted by the clinical condition.

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