Ines B. Menjak
University of Toronto
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Circulation | 2011
Cedric Manlhiot; Ines B. Menjak; Colleen Gruenwald; Steven M. Schwartz; V. Ben Sivarajan; Hyaemin Yoon; Robert Maratta; Caitlin L. Carew; Janet A. McMullen; Nadia A. Clarizia; Helen Holtby; Suzan Williams; Christopher A. Caldarone; Glen S. Van Arsdell; Anthony K.C. Chan; Brian W. McCrindle
Background— Thrombosis, usually considered a serious but rare complication of pediatric cardiac surgery, has not been a major clinical and/or research focus in the past. Methods and Results— We noted 444 thrombi (66% occlusive, 60% symptomatic) in 171 of 1542 surgeries (11%). Factors associated with increased odds of thrombosis were age <31 days (odds ratio [OR], 2.0; P=0.002), baseline oxygen saturation <85% (OR, 2.0; P=0.001), previous thrombosis (OR, 2.6; P=0.001), heart transplantation (OR, 4.1; P<0.001), use of deep hypothermic circulatory arrest (OR, 1.9 P=0.01), longer cumulative time with central lines (OR, 1.2 per 5-day equivalent; P<0.001), and postoperative use of extracorporeal support (OR, 5.2; P<0.001). Serious complications of thrombosis occurred with 64 of 444 thrombi (14%) in 47 of 171 patients (28%), and were associated with thrombus location (intrathoracic, 45%; extrathoracic arterial, 19%; extrathoracic venous, 8%; P<0.001), symptomatic thrombi (OR, 8.0; P=0.02), and partially/fully occluding thrombi (OR, 14.3; P=0.001); indwelling access line in vessel (versus no access line) was associated with lower risk of serious complications (OR, 0.4; P=0.05). Thrombosis was associated with longer intensive care unit (+10.0 days; P<0.001) and hospital stay (+15.2 days; P<0.001); higher odds of cardiac arrest (OR, 4.9; P<0.001), catheter reintervention (OR, 3.3; P=0.002), and reoperation (OR, 2.5; P=0.003); and increased mortality (OR, 5.1; P<0.001). Long-term outcome assessment was possible for 316 thrombi in 129 patients. Of those, 197 (62%) had resolved at the last follow-up. Factors associated with increased odds of thrombus resolution were location (intrathoracic, 75%; extrathoracic arterial, 89%; extrathoracic venous, 60%; P<0.001), nonocclusive thrombi (OR, 2.2; P=0.01), older age at surgery (OR, 1.2 per year; P=0.04), higher white blood cell count (OR, 1.1/109 cells per 1 mL; P=0.002), and lower fibrinogen (OR, 1.4/g/L; P=0.02) after surgery. Conclusions— Thrombosis affects a high proportion of children undergoing cardiac surgery and is associated with suboptimal outcomes. Increased awareness and effective prevention and detection strategies are needed.
The Annals of Thoracic Surgery | 2012
Cedric Manlhiot; Brian W. McCrindle; Ines B. Menjak; Hyeamin Yoon; Helen Holtby; Anthony K.C. Chan; Steven M. Schwartz; V. Ben Sivarajan; Lynn Crawford-Lean; Celeste Foreman; Christopher A. Caldarone; Glen S. Van Arsdell; Colleen Gruenwald
BACKGROUND The negative effects of long-term storage of allogeneic red blood cells (RBCs) on outcomes in adult cardiac surgery have been established, but evidence of a similar effect in pediatric cardiac surgery is limited. METHODS The weighted average duration of storage for RBC units used in 1,225 pediatric cardiac operations was determined. Operations were divided into high RBC use (more than 4 units or more than 150 mL/kg) or low RBC use. For both categories, associations between storage duration and surgical outcomes, adjusted for relevant patient characteristics, were evaluated. RESULTS High RBC use was associated with higher surgical complexity. Storage duration for patients who received low RBC volumes was not associated with surgical outcomes. For patients with high RBC transfusion volumes, longer storage duration (per day) was associated with higher odds of bleeding complications (odds ratio 1.029, p=0.07), renal insufficiency (odds ratio 1.085, p=0.001), higher inotrope score after surgery (12 to 24 hours +0.08, p=0.002; 24 to 48 hours +0.07, p<0.001), greater chest tube drainage (24 hours +1.5 mL/kg, p<0.001), longer postoperative hospitalization (+0.3 days p=0.02), and increased in-hospital mortality (odds ratio 1.054, p=0.03). Effects of RBC transfusions on postoperative bleeding were greatest for storage duration longer than 14 days. CONCLUSIONS The freshest RBC units available should be used for pediatric cardiac operations expected to require more than 4 units or more than 150 mL/kg of allogeneic RBC transfusions, with no units more than 14 days old being transfused whenever possible.
The Journal of Pediatrics | 2012
Cedric Manlhiot; Judith Kwok; Stefan Kegel; Ines B. Menjak; Caitlin L. Carew; Anthony K.C. Chan; Steven M. Schwartz; V. Ben Sivarajan; Christopher A. Caldarone; Glen S. Van Arsdell; Brian W. McCrindle
Canadian Oncology Nursing Journal / Revue canadienne de soins infirmiers en oncologie | 2015
Nemica Thavarajah; Ines B. Menjak; Maureen E. Trudeau; Rajin Mehta; Frances C. Wright; Angela Leahey; Janet Ellis; Damian Gallagher; Jennifer Moore; Bonnie Bristow; Noreen Kay; Ewa Szumacher
Journal of Cancer Education | 2017
Rachel Leifer; Bonnie Bristow; Martine Puts; Shabbir M.H. Alibhai; Xingshan Cao; Barbara-Ann Millar; Meredith Giuliani; Tina Hsu; Maureen E. Trudeau; Rajin Mehta; Ines B. Menjak; Mireille Norris; Barbara Liu; Francois Gallant; E. Szumacher
Canadian Oncology Nursing Journal / Revue canadienne de soins infirmiers en oncologie | 2015
Nemica Thavarajah; Ines B. Menjak; Maureen E. Trudeau; Rajin Mehta; Frances C. Wright; Angela Leahey; Janet Ellis; Damian Gallagher; Jennifer Moore; Bonnie Bristow; Noreen Kay; Ewa Szumacher
Archive | 2013
C. Manlhiot; Ines B. Menjak; Colleen Gruenwald; Steven M. Schwartz; V. Ben Sivarajan; Hyaemin Yoon; Robert Maratta; Caitlin L. Carew; Janet A. McMullen; Nadia A. Clarizia; Helen Holtby; Suzan Williams; Christopher A. Caldarone; Glen S. Van Arsdell; Anthony K.C. Chan; B.W. McCrindle
Circulation | 2011
Cedric Manlhiot; Suzan Williams; Anthony K.C. Chan; Ines B. Menjak; Brian W. McCrindle
Circulation | 2009
Cedric Manlhiot; Ines B. Menjak; Anthony K.C. Chan; Caitlin L. Carew; Steven M. Schwartz; Venkatesan B Sivarajan; Colleen Gruenwald; Brian W. McCrindle
Circulation | 2009
Ines B. Menjak; Cedric Manlhiot; Brian W. McCrindle; Anthony K.C. Chan; Hyeamin Yoon; Glen S. Van Arsdell; Christopher A. Caldarone; Lynn E Crawford; Celeste Foreman; Helen Holtby; Colleen Gruenwald