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Total anomalous pulmonary venous connection (TAPVC) is a complex congenital heart disease, requiring surgical repair. Pulmonary venous obstruction (PVO) is the major complication, with limited effective reinterventions and poor outcomes. This trial aims at investigating that postoperative anticoagulant management reduce the incidence of PVO.
Total anomalous pulmonary venous connection (TAPVC) is a complex congenital heart disease, with all the pulmonary veins connecting to the right heart system through collateral vessels, accounts for about 3% of congenital heart disease. Pulmonary venous obstruction (PVO) is a major complication, with limited effective reinterventions and poor outcomes. The major challenge for surgical repair of TAPVC is to lower the incidence of PVO.
Previous studies in our center showed the abnormal coagulation function, such as elevated International Normalized Ratio (INR), and decreasing of prothrombin activity, are associated with a higher rate of PVO. Some researches suggested that postoperative application of anticoagulants might reduce the incidence of PVO, however, the evidences are still limited. This trial will randomize patients to receive either conventional postoperative management or continuous infusion anticoagulant (Heparin) until the removal of deep vein catheter. The primary endpoint will be incidence of PVO, days of chest drainage more than 40ml/d, and mortality rate. Secondary endpoints including readmission, functional capacity assessment, quality of life and incidence of complications will also be collected.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Conventional treatment group | Active Comparator | Patients in this group will received conventional treatments. Drug: None. Drug: For the high-risk patients, doctors will assess their risk factors and choose continuous infusion heparin (initial dose 10 iu/kg/h and dynamic regulation until the activated coagulation time (ACT) 160-180 s) if needed. Aspirin 5 mg/kg may be given every eight hours subsequently for 3 months. |
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| Anti-coagulant treatment | Experimental | Continuous infusion heparin. Patients in this group will received continuous infusion heparin 6 hours postoperatively (initial dose 10 iu/kg/h, dynamic regulation according to ACT 160-180s). After the removal of deep vein catheter, aspirin 5mg/kg will be given every eight hours subsequently for three months. Study will follow the intention-to-treat principle. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Anticoagulant Solutions | Drug | Patients in this group will received continuous infusion heparin 6 hours postoperatively (initial dose 10 iu/kg/h, dynamic regulation according to ACT 160-180s). After the removal of deep vein catheter, aspirin 5 mg/kg will be given every eight hours subsequently for 3 months. |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of postoperative pulmonary venous obstruction (PVO) | The postoperative PVO were diagnosed by echocardiography or computed tomography scan | 2 years |
| Days of chest drainage | > 40ml/d, assessed during inhospital stay | 2 years |
| Mortality rate | Inhospital or during follow-up, exclude the discharge from hospital against doctors' suggestions. | 2 years |
| Measure | Description | Time Frame |
|---|---|---|
| Level of coagulation indexes. | Blood samples were measured by coagulation function test during follow-up | 2 years |
| Change in resting oxygen saturation | Answer question through telephone or other communication |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Rong Liufu, M.D. | Contact | 020-83827812 | liufurong103@163.com |
| Name | Affiliation | Role |
|---|---|---|
| Jian Zhuang, M.D., Ph D. | Guangdong Provincial People's Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Guangdong Provincial People's Hospital | Recruiting | Guangzhou | Guangdong | 520000 | China |
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| ID | Term |
|---|---|
| D012587 | Scimitar Syndrome |
| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D015619 | Respiratory System Abnormalities |
| D054079 | Vascular Malformations |
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| No anticoagulant solutions | Other | They will receive non-coagulant or coagulant treatment according to clinical conditions. |
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| Anticoagulant management | Drug | Continuous infusion heparin (initial dose 10 iu/kg/h and dynamic regulation until the activated coagulation time (ACT) 160-180 s) for a few days. Aspirin 5 mg/kg will be given every eight hours subsequently for 3 months. |
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| 2 years |
| Value of tricuspid annular plane systolic excursion | Measured by echocardiology from follow-up | 2 years |
| Level of brain natriuretic peptide (BNP) | Measured during follow-up | 2 years |
| D018376 | Cardiovascular Abnormalities |
| D002318 | Cardiovascular Diseases |
| D014652 | Vascular Diseases |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |