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

Objective: The purpose of this study was to determine the risk factors associated with the occurrence of perigraft seromas complicating syst emic-to-pulmonary polytetrafluoroethylene grafts. Methods: Clinical an d perioperative variables mere reexamined, blinded for the outcome var iable perigraft seroma, in 60 patients undergoing 67 consecutive graft procedures in a 3.5-year period. Results: Eight cases of perigraft se roma mere diagnosed in six patients, Univariate analysis revealed age (p = 0.02), a diagnosis of pulmonary atresia with ventricular septal d efect and systemic-pulmonary collaterals (p = 0.001), reimplantation o f collaterals during the procedure (p < 0.001), and intravenous hepari n administered after operation (p < 0.0001) as risk factors for sympto matic 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 th e shunt, directly after operation (p = 0.01), but especially 8 to 10 d ays after operation (p < 0.0001), or the need for prolonged drainage o f pleural fluid (p < 0.0001) were correlated with the occurrence of pe rigraft seroma, Perigraft seroma led to four early rethoracotomies in three patients and to accelerated corrective surgery in three cases. C onsolidation and absent perfusion of lung segments persisted In two pa tients. Conclusions: Our data suggest that the use of heparin leads to an increased risk of perigraft seroma, complicating systemic-pulmonar y polytetrafluoroethylene grafts. Prolonged pleural drainage and/or po stoperative consolidation of the upper lobe indicate the development o f symptomatic perigraft seroma. Treatment is controversial and results are unpredictable. Expectative management seems to be justified so lo ng as permitted by the clinical condition.