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Todd K, Hogue SJ, Tweddell JS, Reagor JA, Mullins E, Block MG, Rosenfeldt L, Francisco B, Jodele S, Sharma BK, Lane A, Slusher C, Kharnaf M, Morales DLS, Palumbo JS. Hemostatic derangements associated with cardiopulmonary bypass predict outcomes in pediatric patients undergoing corrective heart surgery. J Thromb Haemost 2025; 23:492-503. [PMID: 39536815 DOI: 10.1016/j.jtha.2024.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 10/08/2024] [Accepted: 10/11/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Understanding of the hemostatic and complement alterations associated with cardiopulmonary bypass (CPB) in pediatric patients and the impact of these alterations on outcome is limited. OBJECTIVES The present study prospectively characterized these alterations and their association with postoperative outcomes in pediatric CPB. METHODS All patients aged <21 years undergoing CPB at the authors' institution between 2020 and 2021 who weighed >3 kg, were >36 weeks gestational age, and had no known prothrombotic or hemorrhagic disorders were eligible. Blood samples were analyzed for multiple hemostatic and complement biomarkers pre-, intra-, and 24 hours post-CPB. Biomarker levels were compared to clinical outcomes, including chest tube output (CTO). RESULTS Fifty consecutive patients were enrolled. CPB resulted in multiple significant alterations in hemostatic and complement components. Lower platelet counts (<80 × 109 platelets/L) at CPB termination were associated with increased postoperative CTO (P = .003). Lower factor (F)VIII levels (<60 IU/dL) at the end of CPB were associated with a longer hospital stay (P < .001) and increased postoperative CTO (P < .001). Patients undergoing staged single ventricle reconstruction were more likely to have lower platelet counts at CPB termination (P = .009) and higher CTO postoperatively (P = .001) than patients undergoing other types of surgical repair. These differences were not due to different preoperative platelet counts, increased incidences of circulatory arrest, or longer CPB times. CONCLUSION These data suggest that intraoperative alterations in hemostatic system components may predict postoperative outcomes in pediatric CPB. Further study is needed to determine if interventions targeting platelets or FVIII could improve outcomes in pediatric CPB.
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Affiliation(s)
- Kevin Todd
- Division of Hematology, The Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Spencer J Hogue
- Division of Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - James S Tweddell
- Division of Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - James A Reagor
- Division of Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Eric Mullins
- Division of Hematology, The Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mary G Block
- Division of Hematology, The Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Leah Rosenfeldt
- Division of Hematology, The Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brenton Francisco
- Division of Hematology, The Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sonata Jodele
- Division of Bone Marrow Transplantation and Immune Deficiency, The Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Bal Krishan Sharma
- Division of Hematology, The Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Adam Lane
- Division of Hematology, The Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Craig Slusher
- Division of Hematology, The Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mousa Kharnaf
- Division of Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David L S Morales
- Division of Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joseph S Palumbo
- Division of Hematology, The Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Aquino A, Abutalimova N, Ma Y, Ismail-zade I, Grebennik V, Rubinstein A, Kudryavtsev I, Zaikova E, Sambur D, Marichev A, Kalinina O, Bautin A, Kostareva A, Vaage J, Golovkin A. Differences in Plasma Extracellular Vesicles of Different Origin in On-Pump Versus Off-Pump Cardiac Surgery. Curr Issues Mol Biol 2024; 46:13058-13077. [PMID: 39590373 PMCID: PMC11593215 DOI: 10.3390/cimb46110779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 11/12/2024] [Accepted: 11/15/2024] [Indexed: 11/28/2024] Open
Abstract
Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) causes a systemic inflammatory response that can worsen patient outcomes. Off-pump surgery has been associated with a reduced inflammatory response. The precise mechanisms and the role of extracellular vesicles (EVs) in this context are not fully understood. This study aimed to investigate the early immune response, including main T- and B-lymphocyte subsets, cytokine profiles, and plasma EVs, in patients undergoing off-pump (n = 18) and on-pump (n = 18) CABG. Thirty-six patients undergoing isolated CABG were enrolled in this randomized control study. Pre- and 24 h postoperative blood samples were analyzed for immune cell populations, cytokine levels, and plasma EV phenotyping. Off-pump CABG triggered a milder immune response than on-pump surgery. On-pump surgery led to greater changes in circulating EVs, particularly platelet- (CD62P+), endothelial- (CD31+), and B-cell-derived (CD19+), as well as platelet- and erythrocyte-derived aggregates (CD41+CD235a+). Levels of platelet-derived EVs, expressing both constitutional and activation markers (CD41+CD62P+) decreased in both groups of patients 24 h after surgery. On-pump cardiac procedures led to an increase in T-regulatory cell-derived EVs (CD73+CD39+), suggesting a potential mechanism for immune suppression compared to off-pump surgery. There were numerous correlations between EV levels and cytokine profiles following on-pump surgery, hinting at a close relationship. Leucocyte-derived EVs exhibited positive correlations with each other and with GRO but showed negative correlations with endothelial-derived EVs (CD90+ and CD31+). Additionally, CD73+ EVs demonstrated positive correlations with platelet counts and with erythrocyte-derived CD235a+ EVs. EV changes were significantly greater after on-pump surgery, highlighting a more pronounced response to this type of surgery and emphasizing the role of EVs as regulators of post-surgical inflammation.
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Affiliation(s)
- Arthur Aquino
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
| | - Napisat Abutalimova
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
| | - Yi Ma
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
| | - Imran Ismail-zade
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
| | - Vadim Grebennik
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
| | - Artem Rubinstein
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
- Institute of Experimental Medicine, 197022 St. Petersburg, Russia
| | - Igor Kudryavtsev
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
- Institute of Experimental Medicine, 197022 St. Petersburg, Russia
| | - Ekatherina Zaikova
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
| | - Darina Sambur
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
| | - Alexander Marichev
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
| | - Olga Kalinina
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
| | - Andrey Bautin
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
| | - Anna Kostareva
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
| | - Jarle Vaage
- Oslo University Hospital, University of Oslo, 0372 Oslo, Norway;
| | - Alexey Golovkin
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (A.A.); (N.A.); (Y.M.); (I.I.-z.); (V.G.); (A.R.); (I.K.); (E.Z.); (D.S.); (A.M.); (O.K.); (A.B.); (A.K.)
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Magunia H, Azizy E, Krautter L, Rosenberger P, Straub A. Detection of hypofibrinogenemia during cardiac surgery: a comparison of resonance-based thrombelastography with the traditional Clauss method. Blood Coagul Fibrinolysis 2020; 31:551-557. [PMID: 33141779 DOI: 10.1097/mbc.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Bleeding after cardiac surgery is associated with significant morbidity and mortality. Hypofibrinogenemia is a crucial factor for bleeding in this setting and may be rapidly detected using point-of-care viscoelastic tests (POC-VET). However, the correlation of POC-VET with conventional coagulation assays is still unclear. The current study aimed to correlate resonance-based POC-VET assays (Haemonetics TEG 6s) with the traditional nonrapid Clauss method. Another aim was to identify a cut-off value for the detection of hypofibrinogenemia (fibrinogen plasma level below 150 mg/dl) focusing on the maximum amplitude of the TEG 6s citrated functional fibrinogen (CFF) assay. Adult patients undergoing cardiac surgery were screened for inclusion in this single-centre retrospective cohort study. Inclusion criteria were the availability of a TEG assay and timely corresponding laboratory results. Calculation of a CFF-maximum amplitude (CFF-MA) cut-off value was performed using receiver operating curve analysis in the baseline cohort and validated in the control cohort. The best correlation with the Clauss method was observed for the CFF-MA (r = 0.77; P < 0.0001) compared with the citrate kaolin maximum amplitude assay (r = 0.57; P < 0.0001) and the citrate kaolin heparinase maximum amplitude assay (r = 0.67; P < 0.0001). A cut-off value of 19.9 mm for the CFF-MA was calculated [area under the curve 0.87 (95% confidence interval: 0.82-0.92; P < 0.0001)]. This cut-off value had a sensitivity of 81.8% and a specificity of 71.1% for identification of hypofibrinogenemia in the control cohort. The resonance-based thrombelastography analyser can identify hypofibrinogenemia. Future clinical studies should investigate whether cut-off value guided coagulation therapy with POC-VET may improve patient outcomes in patients who suffer from bleeding complications.
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Affiliation(s)
- Harry Magunia
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen
| | - Emily Azizy
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen
| | - Lisa Krautter
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen
| | - Andreas Straub
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen.,Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Oberschwabenklinik, Ravensburg, Germany
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Wang Z, Xia L, Li X, Shen J, Xu Q, Ji Q, Lv Q. Genetic Polymorphisms and Perioperative Bleeding in Off-Pump Coronary Artery Bypass Grafting Surgery. Ann Thorac Surg 2020; 112:116-123. [PMID: 33075321 DOI: 10.1016/j.athoracsur.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clopidogrel use before coronary artery bypass graft surgery may increase risk for perioperative hemorrhage. The effect of genetic polymorphisms related to clopidogrel responses on bleeding during or after off-pump coronary artery bypass graft surgery is unknown. METHODS This prospective study included 206 coronary artery disease patients scheduled for off-pump coronary artery bypass graft surgery. Genotypes were determined using Sequenom MassARRAY system. Severe bleeding was defined by the universal definition of perioperative bleeding in cardiac surgery. RESULTS Patients carrying the ABCB1 3435 wild-type genotype (CC) had a higher risk of severe perioperative bleeding compared with patients carrying the variant genotype (CT or TT; 33.9% vs 16.5%, P = .009). Low baseline hemoglobin level (odds ratio 0.944; 95% confidence interval, 0.917 to 0.972; P < .001), low baseline estimated glomerular filtration rate (odds ratio 0.977; 95% confidence interval, 0.956 to 0.999; P = .041), discontinuing clopidogrel 5 days or less before surgery (odds ratio 2.458; 95% confidence interval, 1.044 to 5.786; P = .039), and the ABCB1 wild-type genotype (CC; odds ratio 2.941; 95% confidence interval, 1.250 to 6.944; P = .014) were independent risk factors for severe perioperative bleeding. CONCLUSIONS Patients carrying the ABCB1 wild-type genotype (CC) had a higher rate of severe perioperative bleeding compared with patients carrying the variant genotype (CT or TT). Discontinuation of clopidogrel 5 days or less before surgery and the ABCB1 wild-type genotype (CC) were independent risk factors for severe perioperative bleeding.
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Affiliation(s)
- Zi Wang
- Department of Clinical Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Limin Xia
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoye Li
- Department of Clinical Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinqiang Shen
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qing Xu
- Department of Clinical Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiuyi Ji
- Department of Clinical Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianzhou Lv
- Department of Clinical Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China.
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Słomka A, Piekuś A, Kowalewski M, Pawliszak W, Anisimowicz L, Żekanowska E. Assessment of the Procoagulant Activity of Microparticles and the Protein Z System in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery. Angiology 2017; 69:347-357. [PMID: 28464697 DOI: 10.1177/0003319717706616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
To understand the coagulation changes after off-pump coronary artery bypass (OPCAB) surgery, we evaluated the procoagulant activity of microparticles (MPs) and microparticles exposing tissue factor (MPs-TF), together with the levels of total tissue factor (TF), protein Z (PZ), protein Z-dependent protease inhibitor (ZPI), and factor X (FX) before (first day) and 1 week after surgery (seventh day) in plasma samples from 30 patients. Twenty healthy controls were also included. Compared to the controls, patients scheduled for surgery had significantly higher MPs-TF procoagulant activity and lower TF levels ( P = .0006, P = .02, respectively). In the whole cohort, median procoagulant activity of MPs-TF and median levels of TF and ZPI were significantly lower ( P = .02, P = .0003, and P = .004, respectively), while median levels of PZ and FX were significantly higher ( P = .02 and P = .002, respectively) on the seventh day compared to the first day. Our results suggest that OPCAB surgery has a significant effect on the procoagulant activity of MPs-TF and the PZ system.
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Affiliation(s)
- Artur Słomka
- 1 Department of Pathophysiology, Nicolaus Copernicus University, Toruń, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Aleksandra Piekuś
- 2 Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
| | - Mariusz Kowalewski
- 2 Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
| | - Wojciech Pawliszak
- 2 Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
| | - Lech Anisimowicz
- 2 Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
| | - Ewa Żekanowska
- 1 Department of Pathophysiology, Nicolaus Copernicus University, Toruń, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
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Prospective evaluation of ADAMTS-13 and von Willebrand factor multimers in cardiac surgery. Blood Coagul Fibrinolysis 2016; 27:886-891. [DOI: 10.1097/mbc.0000000000000510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Parissis H, Lau MC, Parissis M, Lampridis S, Graham V, Al-Saudi R, Mhandu P. Current randomized control trials, observational studies and meta analysis in off-pump coronary surgery. J Cardiothorac Surg 2015; 10:185. [PMID: 26678987 PMCID: PMC4682278 DOI: 10.1186/s13019-015-0391-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 12/08/2015] [Indexed: 12/31/2022] Open
Abstract
The off-pump literature is divided into three eras: the "early phase" with results favouring off-pump surgery supported with randomized control trials (RCTs) mainly from Bristol, UK; an "intermediate phase" dominated by the results of the ROOBY trial and finally a more "contemporary phase" whereby the off/on-pump argument is unsettled. Although the literature has failed to project an overall superiority of off-pump versus on-pump surgery, nevertheless, small randomized control trials and large meta-analysis studies are concluding that the incidence of a stroke is less than 1 % when an aortic off-pump techniques (especially the non-touch technique) are advocated in patients with diseased ascending aorta. Furthermore, off-pump combined with hybrid procedures may lead to a reduction of adverse outcome in the aged high-risk population with concomitant poor left ventricular function and co-morbidities.The current review attempts to bring an insight onto the last ten years knowledge on the on/off-pump debate, with an aim to draw some clear conclusions in order to allow practitioners to reflect on the subject.
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Affiliation(s)
- Haralabos Parissis
- Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland.
| | - Man Chi Lau
- Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland
| | - Mondrian Parissis
- Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland
| | - Savvas Lampridis
- Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland
| | - Victoria Graham
- Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland.
| | - Reza Al-Saudi
- Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland.
| | - Peter Mhandu
- Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland
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Cheungpasitporn W, Thongprayoon C, Kittanamongkolchai W, Srivali N, O'Corragain OA, Edmonds PJ, Ratanapo S, Spanuchart I, Erickson SB. Comparison of renal outcomes in off-pumpversuson-pump coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials. Nephrology (Carlton) 2015; 20:727-735. [DOI: 10.1111/nep.12506] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension; Mayo Clinic; Rochester Minnesota USA
| | | | - Narat Srivali
- Division of Pulmonary and Critical Care Medicine; Mayo Clinic; Rochester Minnesota USA
| | | | - Peter J Edmonds
- Department of Medicine; SUNY Upstate Medical University; Syracuse New York USA
| | - Supawat Ratanapo
- Division of Cardiology; Medical College of Georgia; Augusta Georgia USA
| | | | - Stephen B Erickson
- Division of Nephrology and Hypertension; Mayo Clinic; Rochester Minnesota USA
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Deppe AC, Arbash W, Kuhn EW, Slottosch I, Scherner M, Liakopoulos OJ, Choi YH, Wahlers T. Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of over 16 900 patients investigated in randomized controlled trials. Eur J Cardiothorac Surg 2015; 49:1031-41; discussion 1041. [DOI: 10.1093/ejcts/ezv268] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 07/02/2015] [Indexed: 01/27/2023] Open
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Chow V, Reddel C, Pennings G, Chung T, Ng AC, Curnow J, Kritharides L. Persistent global hypercoagulability in long-term survivors of acute pulmonary embolism. Blood Coagul Fibrinolysis 2015; 26:537-44. [DOI: 10.1097/mbc.0000000000000285] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chow V, Reddel C, Pennings G, Scott E, Pasqualon T, Ng ACC, Yeoh T, Curnow J, Kritharides L. Global hypercoagulability in patients with schizophrenia receiving long-term antipsychotic therapy. Schizophr Res 2015; 162:175-82. [PMID: 25634682 DOI: 10.1016/j.schres.2014.12.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 12/04/2014] [Accepted: 12/06/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with schizophrenia are at increased risk of venous thromboembolism. The mechanisms underlying this association are poorly understood. AIMS We investigated whether there is a global hypercoagulable state in patients with schizophrenia utilising the overall haemostatic potential (OHP) assay which assesses overall coagulation potential (OCP), haemostatic potential (OHP) and fibrinolytic potential (OFP). METHOD Citrated plasma was collected for OHP assays from patients with schizophrenia on long-term antipsychotic treatment and compared with healthy age- and sex-matched controls. Time courses of fibrin formation and degradation were measured by spectrophotometry (absorption of 405nm) after the addition of tissue factor and tissue plasminogen activator to plasma. RESULTS Ninety patients with schizophrenia (antipsychotic treatment-15.9±9.7years) and 30 controls were recruited. Patients with schizophrenia had higher rates of smoking and levels of inflammatory markers (high-sensitivity C-reactive protein and neutrophil-to-lymphocyte ratio) than controls. Whilst D-dimer, fibrinogen and platelet count did not differ between patients with schizophrenia and controls, the OCP (54.0±12.6 vs 45.9±9.1, p=0.002) and OHP (12.6±5.8 vs 7.2±3.7, p<0.001) were higher, and OFP was lower (76.6±9.8% vs 84.9±6.4%, p<0.001) in patients with schizophrenia, implying both a hypercoagulable and hypofibrinolytic state in these patients. Importantly, abnormalities in overall coagulation were independently predicted by levels of plasminogen-activator-inhibitor-1, fibrinogen, platelet count, inflammatory markers and plasma triglycerides, suggesting a multifactorial aetiology. CONCLUSION Patients with schizophrenia have evidence of a global hypercoagulable and hypofibrinolytic state which may contribute to their increased risk of venous thromboembolism.
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Affiliation(s)
- Vincent Chow
- ANZAC Research Institute, Sydney, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney Local Health District, Sydney, Australia; University of Sydney, Australia
| | - Caroline Reddel
- ANZAC Research Institute, Sydney, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney Local Health District, Sydney, Australia; University of Sydney, Australia
| | - Gabrielle Pennings
- ANZAC Research Institute, Sydney, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney Local Health District, Sydney, Australia; University of Sydney, Australia
| | - Elizabeth Scott
- Brain & Mind Research Institute, University of Sydney, Australia
| | - Tundra Pasqualon
- Department of Psychiatry, Croydon Health Centre, Sydney, Australia
| | - Austin C C Ng
- Department of Cardiology, Concord Repatriation General Hospital, Sydney Local Health District, Sydney, Australia; University of Sydney, Australia
| | - Thomas Yeoh
- Department of Cardiology, Concord Repatriation General Hospital, Sydney Local Health District, Sydney, Australia
| | - Jennifer Curnow
- ANZAC Research Institute, Sydney, Australia; University of Sydney, Australia; Department of Haematology, Concord Repatriation General Hospital, Sydney Local Health District, Sydney, Australia
| | - Leonard Kritharides
- ANZAC Research Institute, Sydney, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney Local Health District, Sydney, Australia; University of Sydney, Australia.
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12
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Roy S, Saha K, Mukherjee K, Dutta S, Mukhopadhyay D, Das I, Raychaudhuri G. Activation of coagulation and fibrinolysis during coronary artery bypass grafting: a comparison between on-pump and off-pump techniques. Indian J Hematol Blood Transfus 2013; 30:333-41. [PMID: 25435738 DOI: 10.1007/s12288-013-0250-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 03/13/2013] [Indexed: 10/26/2022] Open
Abstract
Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) is associated with intense activation of hemostatic mechanisms. But the precise knowledge of the effects of eliminating CPB in patients undergoing off-pump coronary artery bypass grafting (CABG) are not well established. The present study was carried out to compare and document the changes in selected coagulation and fibrinolysis variables in patients undergoing on-pump and off-pump CABG (OPCAB). A total of 42 patients of on-pump and 31 patients of off-pump CABG were selected for the study. Platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), Fibrinogen and D-dimer levels were measured immediately, 24 h and 7 days after operation and compared with the baseline preoperative values. Statistical analysis was done by mixed ANOVA for repeated measures and Post-hoc tests using the Bonferroni correction, Chi square and unpaired t test. All the parameters were significantly changed (P < 0.05) with the time. Platelet counts, fibrinogen and D-dimer levels were significantly different between on-pump and off-pump CABG patients on immediate and 24 h postoperative period and attained almost same level after 7 days of operation. Fibrinogen level and platelet counts were increased after a sharp fall in the immediate post-operative period whereas D-dimer levels were persistently increased with a sharp peak of rise in the immediate post-operative period in on-pump group. On-pump surgery was associated with excessive fibrinolytic activity immediately after operation. The off-pump group demonstrated less activation of coagulation and fibrinolysis and delayed postoperative response that became almost equal to the on-pump group in the later postoperative period.
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Affiliation(s)
- Shreosee Roy
- Department of Pathology, IPGME & R, Kolkata, India ; Ganganiketan, Jamtala, Kalna Road, Burdwan, 713101 India
| | - Kaushik Saha
- Department of Pathology, IPGME & R, Kolkata, India ; 42/9/2, Sashi Bhusan Neogi Garden Lane, Baranagar, Kolkata, 700 036 India
| | - Krishnendu Mukherjee
- Department of Immunohematology and Transfusion Medicine, Medical College, Kolkata, India
| | - Santanu Dutta
- Department of Cardiothoracic Surgery, IPGME & R, Kolkata, India
| | | | - Indranil Das
- Department of Pathology, IPGME & R, Kolkata, India
| | - Gargi Raychaudhuri
- Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
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13
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Møller CH, Penninga L, Wetterslev J, Steinbrüchel DA, Gluud C. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. Cochrane Database Syst Rev 2012; 2012:CD007224. [PMID: 22419321 PMCID: PMC11809671 DOI: 10.1002/14651858.cd007224.pub2] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is performed both without and with cardiopulmonary bypass, referred to as off-pump and on-pump CABG respectively. However, the preferable technique is unclear. OBJECTIVES To assess the benefits and harms of off-pump versus on-pump CABG in patients with ischaemic heart disease. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 1, 2011), MEDLINE (OVID, 1950 to February 2011), EMBASE (OVID, 1980 to February 2011), Science Citation Index Expanded on ISI Web of Science (1970 to February 2011) and CINAHL (EBSCOhost, 1981 to February 2011) on 2 February 2011. No language restrictions were applied. SELECTION CRITERIA Randomised clinical trials of off-pump versus on-pump CABG irrespective of language, publication status and blinding were selected for inclusion. DATA COLLECTION AND ANALYSIS For statistical analysis of dichotomous data risk ratio (RR) and for continuous data mean difference (MD) with 95% confidence intervals (CI) were used. Trial sequential analysis (TSA) was used for analysis to assess the risk of random error due to sparse data and to multiple updating of accumulating data. MAIN RESULTS Eighty-six trials (10,716 participants) were included. Ten trials (4,950 participants) were considered to be low risk of bias. Pooled analysis of all trials showed that off-pump CABG increased all-cause mortality compared with on-pump CABG (189/5,180 (3.7%) versus 160/5144 (3.1%); RR 1.24, 95% CI 1.01 to 1.53; P =.04). In the trials at low risk of bias the effect was more pronounced (154/2,485 (6.2%) versus 113/2,465 (4.6%), RR 1.35,95% CI 1.07 to 1.70; P =.01). TSA showed that the risk of random error on the result was unlikely. Off-pump CABG resulted in fewer distal anastomoses (MD -0.28; 95% CI -0.40 to -0.16, P <.00001). No significant differences in myocardial infarction, stroke, renal insufficiency, or coronary re-intervention were observed. Off-pump CABG reduced post-operative atrial fibrillation compared with on-pump CABG, however, in trials at low risk of bias, the estimated effect was not significantly different. AUTHORS' CONCLUSIONS Our systematic review did not demonstrate any significant benefit of off-pump compared with on-pump CABG regarding mortality, stroke, or myocardial infarction. In contrast, we observed better long-term survival in the group of patients undergoing on-pump CABG with the use of cardiopulmonary bypass and cardioplegic arrest. Based on the current evidence, on-pump CABG should continue to be the standard surgical treatment. However, off-pump CABG may be acceptable when there are contraindications for cannulation of the aorta and cardiopulmonary bypass. Further randomised clinical trials should address the optimal treatment in such patients.
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Affiliation(s)
- Christian H Møller
- Department of Cardiothoracic Surgery, RT 2152, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
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14
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Bleeding-associated outcomes with preoperative clopidogrel use in on- and off-pump coronary artery bypass. J Thromb Thrombolysis 2012; 34:56-64. [DOI: 10.1007/s11239-012-0694-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Is fibrin formation and thrombin generation increased during and after an acute coronary syndrome? Thromb Res 2011; 128:483-9. [DOI: 10.1016/j.thromres.2011.03.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 03/11/2011] [Accepted: 03/17/2011] [Indexed: 11/21/2022]
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16
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Raja SG, Akhtar S. Hypercoagulable state after off-pump coronary artery bypass grafting: evidence, mechanisms and implications. Expert Rev Cardiovasc Ther 2011; 9:599-608. [PMID: 21615323 DOI: 10.1586/erc.11.51] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
During the past decade, there has been a dramatic resurgence in the adoption of off-pump technology in coronary artery bypass surgery. This has inspired remarkable advances in the techniques of localized tissue stabilization and a greater understanding of the physiology of beating-heart mobilization and exposure. An avalanche of reports in the literature has demonstrated the early safety and efficacy of the procedure. However, despite abundant evidence validating the safety and efficacy of off-pump coronary artery bypass surgery, considerable controversy still persists regarding the long-term outcomes of this approach to myocardial revascularization. One area of concern, and even greater uncertainty, surrounds the issue of the existence of a hypercoagulable state after off-pump coronary artery bypass surgery. This article evaluates the current best evidence available from randomized controlled trials to assess the impact of off-pump coronary artery bypass surgery on coagulation, fibrinolysis and platelet activation, discusses the issue of hypercoagulability with emphasis on the mechanisms responsible for this actual or potential hypercoagulability, and explores the implications of this issue for clinical practice.
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Affiliation(s)
- Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, Harefield, London, UB9 6JH, UK.
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17
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Yachi T, Watanabe G, Tomita S. Activation of Coagulation and Fibrinolysis after Off-Pump Coronary Artery Bypass Grafting with or without Endotracheal General Anesthesia. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010; 5:444-9. [DOI: 10.1177/155698451000500611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective In this study, we measured the activity of coagulation and fibrinolysis and clarified the presence of certain differences between off-pump coronary artery bypass grafting (OPCAB) cases and awake off-pump coronary artery bypass grafting (AOCAB) cases to evaluate whether AOCAB is actually safe from the viewpoint of coagulability. Methods 8 underwent OPCAB and 6 underwent AOCAB. The following factors inducing coagulation and fibrinolysis were measured for upto 5 days after the operation: platelet counts, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin degeneration products, D-dimer, thrombin-antithrombin III complex (TAT), α2-plasmin inhibitor-plasmin complex, prothrombin fragment 1, 2 (F1+2), thrombomodulin, β-thromboglobulin (β-TG), and platelet factor-4. Results At 5 days after the operation, fibrin degeneration products, D-dimer, α2–plasmin inhibitor-plasmin complex, and F1 + 2 levels of the OPCAB group were significantly higher compared with their baseline values and those of the AOCAB group. At 5 days after the operation, thrombin-antithrombin III complex levels of the OPCAB group were significantly higher than those of the AOCAB group. Fibrinogen levels of the OPCAB group were significantly higher than their baseline values at 3 days after the operation (POD3) and 5 days after the operation (POD5). Conclusions In this study, the hypercoagulable state at POD5 was suggested in the patients in the OPCAB group, but not in those in the AOCAB group. Further study is necessary to confirm these results, and future studies would evaluate the potential benefit of AOCAB procedure from the viewpoint of perioperative coagulability.
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Affiliation(s)
- Tsuyoshi Yachi
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Go Watanabe
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Shigeyuki Tomita
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
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18
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Seabra VF, Alobaidi S, Balk EM, Poon AH, Jaber BL. Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized controlled trials. Clin J Am Soc Nephrol 2010; 5:1734-44. [PMID: 20671222 DOI: 10.2215/cjn.02800310] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Off-pump coronary artery bypass grafting (CABG) has been advocated to cause less inflammation, morbidity, and mortality than the more traditional on-pump technique. This meta-analysis compares these two surgical techniques with respect to causing acute kidney injury (AKI). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study searched for randomized controlled trials in MEDLINE and abstracts from the proceedings of scientific meetings through February 2010. Included were trials comparing off-pump to on-pump CABG that reported the incidence of AKI, as defined by a mixture of criteria including biochemical parameter/urine output/dialysis requirement. Mortality was evaluated among the studies that reported kidney-related outcomes. For primary and subgroup analyses, fixed-effect meta-analyses of odds ratios (OR) were performed. RESULTS In 22 identified trials (4819 patients), the weighted incidence of AKI in the on-pump CABG group was 4.0% (95% confidence interval [CI] 1.8%, 8.5%), dialysis requirement 2.4% (95% CI 1.6%, 3.7%), and mortality 2.6% (95% CI 1.6%, 4.0%). By meta-analysis, off-pump CABG was associated with a 40% lower odds of postoperative AKI (OR 0.60; 95% CI 0.43, 0.84; P = 0.003) and a nonsignificant 33% lower odds for dialysis requirement (OR 0.67; 95% CI 0.40, 1.12; P = 0.12). Within the selected trials, off-pump CABG was not associated with a significant decrease in mortality. CONCLUSIONS Off-pump CABG may be associated with a lower incidence of postoperative AKI but may not affect dialysis requirement, a serious complication of cardiac surgery. However, the different definitions of AKI used in individual trials and methodological concerns preclude definitive conclusions.
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Affiliation(s)
- Victor F Seabra
- Department of Medicine, Division of Nephrology, Kidney and Dialysis Research Laboratory, St. Elizabeth's Medical Center, Boston, Massachusetts 02135, USA
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19
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Senay S, Toraman F, Karabulut H, Alhan C. Efficiency of Preoperative Tranexamic Acid in Coronary Bypass Surgery: An Analysis Correlated with Preoperative Clopidogrel Use. Heart Surg Forum 2010; 13:E149-54. [DOI: 10.1532/hsf98.20091176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Nakahira A, Sasaki Y, Hirai H, Fukui T, Matsuo M, Takahashi Y, Kotani S, Suehiro S. Closed cardiopulmonary bypass circuits suppress thrombin generation during coronary artery bypass grafting☆. Interact Cardiovasc Thorac Surg 2010; 10:555-60. [DOI: 10.1510/icvts.2009.214437] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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21
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Vaccarino GN, Thierer J, Albertal M, Vrancic M, Piccinini F, Benzadón M, Raich H, Navia DO. Impact of preoperative clopidogrel in off pump coronary artery bypass surgery: A propensity score analysis. J Thorac Cardiovasc Surg 2009; 137:309-13. [DOI: 10.1016/j.jtcvs.2008.08.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 04/24/2008] [Accepted: 08/04/2008] [Indexed: 12/30/2022]
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22
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Møller CH, Penninga L, Wetterslev J, Steinbrüchel DA, Gluud C. Clinical outcomes in randomized trials of off- vs. on-pump coronary artery bypass surgery: systematic review with meta-analyses and trial sequential analyses. Eur Heart J 2008; 29:2601-16. [PMID: 18628261 DOI: 10.1093/eurheartj/ehn335] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To assess the clinical outcomes of off- vs. on-pump coronary artery bypass surgery in randomized trials. METHODS AND RESULTS We searched electronic databases and bibliographies until June 2007. Trials were assessed for risk of bias. Outcome measures were all-cause mortality, myocardial infarction, stroke, atrial fibrillation, and renewed coronary revascularization at maximum follow-up. We applied trial sequential analysis to estimate the strength of evidence. We found 66 randomized trials. There was no statistically significant differences regarding mortality [relative risk (RR) 0.98; 95% confidence interval (CI) 0.66-1.44], myocardial infarction (RR 0.95; 95% CI 0.65-1.37), or renewed coronary revascularization (RR 1.34; 95% CI 0.83-2.18). We found a significant reduced risk of atrial fibrillation (RR 0.69; 95% CI 0.57-0.83) and stroke (RR 0.53; 95% CI 0.31-0.91) in off-pump patients. However, when continuity correction for zero-event trials was included, the reduction in stroke became insignificant (RR 0.62; 95% CI 0.32-1.19). Trial sequential analysis demonstrated overwhelming evidence supporting that off-pump bypass surgery reduces atrial fibrillation. CONCLUSION Off-pump surgery reduces the risks of postoperative atrial fibrillation compared with on-pump surgery. For death, myocardial infarction, stroke, and renewed coronary revascularization, the evidence is still weak and more low-bias risk trials are needed.
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Affiliation(s)
- Christian H Møller
- Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Onorati F, Esposito A, Comi MC, Impiombato B, Cristodoro L, Mastroroberto P, Renzulli A. Intra-aortic Balloon Pump-induced Pulsatile Flow Reduces Coagulative and Fibrinolytic Response to Cardiopulmonary Bypass. Artif Organs 2008; 32:433-41. [DOI: 10.1111/j.1525-1594.2008.00563.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Snyder TA, Litwak KN, Tsukui H, Akimoto T, Kihara S, Yamazaki K, Wagner WR. Leukocyte-platelet aggregates and monocyte tissue factor expression in bovines implanted with ventricular assist devices. Artif Organs 2007; 31:126-31. [PMID: 17298401 DOI: 10.1111/j.1525-1594.2007.00351.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infection and thromboembolism remain significant complications associated with ventricular assist device (VAD) support, including the newer rotary VADs, limiting wider adoption of this promising technology. These complications persist in spite of extensive preclinical testing in large animal models. The amount of biocompatibility information collected during preclinical trials is limited due to a lack of available assays. We thus developed three flow cytometric assays to measure leukocyte-platelet aggregates and monocyte tissue factor expression and applied them to 26 bovines implanted with two types of rotary VADs. All animals displayed low levels of circulating aggregates and monocytes expressing tissue factor prior to device implant. The assay values significantly increased following VAD implant, then usually declined to a lower, yet significantly elevated versus baseline, level indicative of ongoing inflammation. The implementation of more robust biocompatibility assays for the evaluation of cardiovascular device performance and modification might ultimately contribute to the development of safer artificial organs.
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Affiliation(s)
- Trevor A Snyder
- Bioengineering Department, University of Pittsburgh, Pittsburgh, USA
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Gurbuz AT, Findik O, Cui H, Aytac A. Radial artery graft use and off-pump coronary artery bypass surgery outcome. Asian Cardiovasc Thorac Ann 2007; 15:106-12. [PMID: 17387191 DOI: 10.1177/021849230701500206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Radial artery is commonly used as a conduit for surgical revascularization. There is scarce data on the effect of radial artery use on outcome following off-pump coronary artery bypass. We prospectively evaluated 591 patients undergoing off-pump coronary artery bypass. Radial artery grafts were used in 398 of these patients (mean age, 67.6 +/- 10.4 years; mean follow-up, 37.7 +/- 13.4 months). Symptom recurrence (angina, congestive heart failure), adverse cardiac events (myocardial infarction, coronary re-intervention, sudden cardiac death), and overall mortality were recorded. Multivariate Cox regression analysis was used to evaluate predictors of endpoints. Patients with and without radial artery grafts were similar with respect to preoperative risk factors. Recurrent angina developed in 29 patients, congestive heart failure in 5, and myocardial infarction in 9. Coronary arteriography was performed in 27 patients, and 23 underwent re-intervention. Radial artery graft was an independent predictor of increased symptom recurrence and adverse cardiac events. Patients with radial artery grafts also had a tendency towards more angina recurrence, coronary re-intervention, and sudden cardiac death.
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Affiliation(s)
- Ahmet T Gurbuz
- Department of Cardiothoracic Surgery, Tucson Medical Center, University of Arizona, Tucson, USA.
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Jares M, Vanek T, Bednar F, Maly M, Snircova J, Straka Z. Off-Pump Versus On-Pump Coronary Artery Surgery Identification of Fibrinolysis Using Rotation Thromboelastography; A Preliminary, Prospective, Randomized Study. Int Heart J 2007; 48:57-67. [PMID: 17379979 DOI: 10.1536/ihj.48.57] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this preliminary, prospective, randomized study was to compare rotation thromboelastography (roTEG) results and D-dimer levels in off-pump versus on-pump coronary surgery in order to identify the activation of fibrinolysis. Twenty patients scheduled for coronary bypass grafting were assessed (off-pump group A, n = 10; on-pump group B, n = 10). Blood samples for roTEG examination were taken preoperatively (t0), 15 minutes after sternotomy (t1), on the completion of peripheral bypass anastomoses (t2), and at the end of procedures (t3). The time points for D-dimer levels analyses were before operation, at the end of procedures, and 24 hours later. A certain degree of roTEG signs of fibrinolysis was noticed at time t2 in both groups and in group B these marks were quite widely, but not significantly expressed (P for intergroup differences for Lysis on Set Time at 60 and 150 minutes were P = 0.190 and P = 0.122, respectively), borderline differences were found for Maximum Clot Firmness (P = 0.082) with a lower mean value for group B (arithmetic means [95% confidence intervals]--57.7 [54.2; 61.2] mm). Completely expressed roTEG signs of hyperfibrinolysis were observed in 2 patients from group B. In group B also the highest geometric means of D-dimers (1326.0 [943.5; 1863.6] ng mL(-1)) and thus a dramatic intergroup difference (P < 0.001) were observed at the end of surgery; 24 hours later the significantly elevated D-dimer levels in both groups (A: 1070.0 [723.5; 1582.6] versus B: 1093.3 [732.0; 1632.9] ng mL(-1)) were equalized (P = 0.932). Our roTEG results display a slightly greater, but fairly subtle activation of fibrinolysis during the course of cardiopulmonary bypass, compared to off-pump cardiac surgery.
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Affiliation(s)
- Martin Jares
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University in Prague, Kralovske Vinohrady University Hospital, Prague, Czech Republic
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