Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Inna Lobeck
Start Date
13-5-2025 11:30 AM
End Date
13-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Introduction
Congenital Diaphragmatic Hernia (CDH) is a rare congenital anomaly. The pulmonary hypoplasia, pulmonary hypertension and altered cardiac function associated with CDH may result in early cardiorespiratory failure requiring life-saving extracorporeal life support (ECLS). Early repair of CDH on ECLS has shown to improve survival, but poses an increased bleeding risk due to anticoagulation. Heparin has traditionally been the anticoagulant of choice for ECLS. Recent data has suggested that the use of bivalirudin may result in lower bleeding rates and transfusion requirements. This study aims to stratify complications for patients with CDH repaired on heparin versus bivalirudin, hypothesizing that complications will be less with the new anticoagulant.
Methods
A retrospective review was performed at our institution from 01/2024- 02/2025 assessing all patients who underwent CDH repair while on ECLS. Patients were stratified based on which anticoagulant they were on at the time of repair and primary endpoints were major bleeding and peri-operative bleeding events. Secondary endpoints included clotting events and daily transfusion requirements
Results
38 patients underwent repair of CDH during this timeframe, 31 while on Heparin and 7 while on Bivalirudin. Mortality was similar in the two groups. While not reaching statistical significance, there was a trend toward higher rates of bleeding events during the ECLS course as well as perioperative bleeding events in those on Heparin. There was a statistically significant lower transfusion requirement of PRBCs in patients on Bivalirudin as compared to Heparin.
Conclusions
Patient bleeding and clotting events tended to be less in CDH patients treated with ECLS when anticoagulated with Bivalirudin as compared to Heparin. With a higher sample size we believe these rates may be substantiated statistically. Continued analysis and multicenter collaboration will help elucidate the risk-benefit profile of these two anticoagulants in patients with CDH requiring ECLS.
Bivalirudin versus Heparin in patients with Congenital Diaphragmatic Hernias requiring extracorporeal life support
Introduction
Congenital Diaphragmatic Hernia (CDH) is a rare congenital anomaly. The pulmonary hypoplasia, pulmonary hypertension and altered cardiac function associated with CDH may result in early cardiorespiratory failure requiring life-saving extracorporeal life support (ECLS). Early repair of CDH on ECLS has shown to improve survival, but poses an increased bleeding risk due to anticoagulation. Heparin has traditionally been the anticoagulant of choice for ECLS. Recent data has suggested that the use of bivalirudin may result in lower bleeding rates and transfusion requirements. This study aims to stratify complications for patients with CDH repaired on heparin versus bivalirudin, hypothesizing that complications will be less with the new anticoagulant.
Methods
A retrospective review was performed at our institution from 01/2024- 02/2025 assessing all patients who underwent CDH repair while on ECLS. Patients were stratified based on which anticoagulant they were on at the time of repair and primary endpoints were major bleeding and peri-operative bleeding events. Secondary endpoints included clotting events and daily transfusion requirements
Results
38 patients underwent repair of CDH during this timeframe, 31 while on Heparin and 7 while on Bivalirudin. Mortality was similar in the two groups. While not reaching statistical significance, there was a trend toward higher rates of bleeding events during the ECLS course as well as perioperative bleeding events in those on Heparin. There was a statistically significant lower transfusion requirement of PRBCs in patients on Bivalirudin as compared to Heparin.
Conclusions
Patient bleeding and clotting events tended to be less in CDH patients treated with ECLS when anticoagulated with Bivalirudin as compared to Heparin. With a higher sample size we believe these rates may be substantiated statistically. Continued analysis and multicenter collaboration will help elucidate the risk-benefit profile of these two anticoagulants in patients with CDH requiring ECLS.
