Cohort Demographics and Intraoperative Management
We identified 95 patients (5 to 35 months of age) who underwent CCVR at MCJCHV between September 2015 and December 2019. All of the patients were cared for by the same pediatric plastic surgeon and pediatric neurosurgeon. Overall, 47 patients received EACA and 48 received TXA. Dosing regimen was largely equivalent for patients in each antifibrinolytic group, although a few patients received slightly different dosing regimen based on the anesthesiologist’s preference. These minor dosing variations were equal between groups. There were no major differences in demographics between the two cohorts, except that there were slightly more syndromic patients in the EACA group (Table 1). There was no difference in operative time or ICU length of stay, but the total hospital length of stay was slightly longer in the TXA group. There were more intraoperative complications in the EACA group and more postoperative complications in the TXA group, but neither reached statistical significance (Table 1). Intraoperative complications included hypotension and possible venous air embolism. Postoperative complications included two patients with new-onset seizure activity, one minor local allergic reaction, three patients requiring repeat operation (two for infectious complications, one for proptosis), one transfusion reaction, and two postoperative thromboembolic events (Table 2). Both postoperative thromboembolic events were associated with arterial lines placed for the procedure. One did not require any intervention. The other was treated with anticoagulation for ~2.5 months with complete resolution.