Congenital cardiac lesions involving systolic flow abnormalities are associated with platelet dysfunction in children

David K. Bailly, Lynn Boshkov, M. Mujeeb Zubair, Vanessa J C Rogers, Gurion Lantz, Laurie Armsby, Alan (Roger) Hohimer, Julie Martchenke, Paul Sochacki, Stephen M. Langley

Research output: Contribution to journalArticle

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Abstract

Background. Shear stress-induced platelet dysfunction (PD) is prevalent among adults with aortic stenosis. Our aim was to determine whether abnormal platelet function was associated with specific congenital cardiac lesions in children.

Methods. The charts of 407 children who had undergone cardiopulmonary bypass and had preoperative platelet function analysis were evaluated. Patients were assigned to 1 of 11 different lesion categories. Platelet dysfunction (PD) was defined as prolonged closure time (CT) as measured with a platelet function analyzer. Odds ratio (OR) estimates for prolonged CT were calculated for each lesion category. Mean CTs were compared wit Tukey-Kramer separated means testing. Analysis of variance modeling was used to determine association between hematocrit value and CT.m

Results. CT in patients with ventricular septal defects (VSD) and right ventricular outflow tract obstruction (RVOTO) lesions was prolonged. OR analysis found that patients with VSDs (OR, 2.46) or RVOTO (OR, 2.88) had at least a 95% probability of an abnormal CT. In contrast, patients with atrial septal defect (ASD), bidirectional Glenn procedure (BDG), and pulmonary insufficiency (PI) had a reduced probability of a prolonged CT (p <0.05). A similar pattern was seen in parametric analysis comparing mean CTs across lesion categories. a lower preoperative hematocrit value was associated with prolonged CTs across all lesion types (p <0.05).

Conclusions. PD was common in children withm congenital cardiac lesions involving systolic flow abnormalities and was uncommon among children with lesions having diastolic abnormalities. Lower preoperative hematocrit values were associated with prolonged CTs, suggesting subclinical bleeding secondary to excessive platelet shearing.

Original languageEnglish (US)
Pages (from-to)1419-1424
Number of pages6
JournalAnnals of Thoracic Surgery
Volume98
Issue number4
DOIs
StatePublished - Oct 1 2014

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Blood Platelets
Odds Ratio
Hematocrit
Ventricular Outflow Obstruction
Fontan Procedure
Wit and Humor
Atrial Heart Septal Defects
Ventricular Heart Septal Defects
Aortic Valve Stenosis
Cardiopulmonary Bypass
Analysis of Variance
Hemorrhage
Lung

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Congenital cardiac lesions involving systolic flow abnormalities are associated with platelet dysfunction in children. / Bailly, David K.; Boshkov, Lynn; Zubair, M. Mujeeb; Rogers, Vanessa J C; Lantz, Gurion; Armsby, Laurie; Hohimer, Alan (Roger); Martchenke, Julie; Sochacki, Paul; Langley, Stephen M.

In: Annals of Thoracic Surgery, Vol. 98, No. 4, 01.10.2014, p. 1419-1424.

Research output: Contribution to journalArticle

Bailly, DK, Boshkov, L, Zubair, MM, Rogers, VJC, Lantz, G, Armsby, L, Hohimer, AR, Martchenke, J, Sochacki, P & Langley, SM 2014, 'Congenital cardiac lesions involving systolic flow abnormalities are associated with platelet dysfunction in children', Annals of Thoracic Surgery, vol. 98, no. 4, pp. 1419-1424. https://doi.org/10.1016/j.athoracsur.2014.05.035
Bailly, David K. ; Boshkov, Lynn ; Zubair, M. Mujeeb ; Rogers, Vanessa J C ; Lantz, Gurion ; Armsby, Laurie ; Hohimer, Alan (Roger) ; Martchenke, Julie ; Sochacki, Paul ; Langley, Stephen M. / Congenital cardiac lesions involving systolic flow abnormalities are associated with platelet dysfunction in children. In: Annals of Thoracic Surgery. 2014 ; Vol. 98, No. 4. pp. 1419-1424.
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abstract = "Background. Shear stress-induced platelet dysfunction (PD) is prevalent among adults with aortic stenosis. Our aim was to determine whether abnormal platelet function was associated with specific congenital cardiac lesions in children.Methods. The charts of 407 children who had undergone cardiopulmonary bypass and had preoperative platelet function analysis were evaluated. Patients were assigned to 1 of 11 different lesion categories. Platelet dysfunction (PD) was defined as prolonged closure time (CT) as measured with a platelet function analyzer. Odds ratio (OR) estimates for prolonged CT were calculated for each lesion category. Mean CTs were compared wit Tukey-Kramer separated means testing. Analysis of variance modeling was used to determine association between hematocrit value and CT.mResults. CT in patients with ventricular septal defects (VSD) and right ventricular outflow tract obstruction (RVOTO) lesions was prolonged. OR analysis found that patients with VSDs (OR, 2.46) or RVOTO (OR, 2.88) had at least a 95{\%} probability of an abnormal CT. In contrast, patients with atrial septal defect (ASD), bidirectional Glenn procedure (BDG), and pulmonary insufficiency (PI) had a reduced probability of a prolonged CT (p <0.05). A similar pattern was seen in parametric analysis comparing mean CTs across lesion categories. a lower preoperative hematocrit value was associated with prolonged CTs across all lesion types (p <0.05).Conclusions. PD was common in children withm congenital cardiac lesions involving systolic flow abnormalities and was uncommon among children with lesions having diastolic abnormalities. Lower preoperative hematocrit values were associated with prolonged CTs, suggesting subclinical bleeding secondary to excessive platelet shearing.",
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T1 - Congenital cardiac lesions involving systolic flow abnormalities are associated with platelet dysfunction in children

AU - Bailly, David K.

AU - Boshkov, Lynn

AU - Zubair, M. Mujeeb

AU - Rogers, Vanessa J C

AU - Lantz, Gurion

AU - Armsby, Laurie

AU - Hohimer, Alan (Roger)

AU - Martchenke, Julie

AU - Sochacki, Paul

AU - Langley, Stephen M.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Background. Shear stress-induced platelet dysfunction (PD) is prevalent among adults with aortic stenosis. Our aim was to determine whether abnormal platelet function was associated with specific congenital cardiac lesions in children.Methods. The charts of 407 children who had undergone cardiopulmonary bypass and had preoperative platelet function analysis were evaluated. Patients were assigned to 1 of 11 different lesion categories. Platelet dysfunction (PD) was defined as prolonged closure time (CT) as measured with a platelet function analyzer. Odds ratio (OR) estimates for prolonged CT were calculated for each lesion category. Mean CTs were compared wit Tukey-Kramer separated means testing. Analysis of variance modeling was used to determine association between hematocrit value and CT.mResults. CT in patients with ventricular septal defects (VSD) and right ventricular outflow tract obstruction (RVOTO) lesions was prolonged. OR analysis found that patients with VSDs (OR, 2.46) or RVOTO (OR, 2.88) had at least a 95% probability of an abnormal CT. In contrast, patients with atrial septal defect (ASD), bidirectional Glenn procedure (BDG), and pulmonary insufficiency (PI) had a reduced probability of a prolonged CT (p <0.05). A similar pattern was seen in parametric analysis comparing mean CTs across lesion categories. a lower preoperative hematocrit value was associated with prolonged CTs across all lesion types (p <0.05).Conclusions. PD was common in children withm congenital cardiac lesions involving systolic flow abnormalities and was uncommon among children with lesions having diastolic abnormalities. Lower preoperative hematocrit values were associated with prolonged CTs, suggesting subclinical bleeding secondary to excessive platelet shearing.

AB - Background. Shear stress-induced platelet dysfunction (PD) is prevalent among adults with aortic stenosis. Our aim was to determine whether abnormal platelet function was associated with specific congenital cardiac lesions in children.Methods. The charts of 407 children who had undergone cardiopulmonary bypass and had preoperative platelet function analysis were evaluated. Patients were assigned to 1 of 11 different lesion categories. Platelet dysfunction (PD) was defined as prolonged closure time (CT) as measured with a platelet function analyzer. Odds ratio (OR) estimates for prolonged CT were calculated for each lesion category. Mean CTs were compared wit Tukey-Kramer separated means testing. Analysis of variance modeling was used to determine association between hematocrit value and CT.mResults. CT in patients with ventricular septal defects (VSD) and right ventricular outflow tract obstruction (RVOTO) lesions was prolonged. OR analysis found that patients with VSDs (OR, 2.46) or RVOTO (OR, 2.88) had at least a 95% probability of an abnormal CT. In contrast, patients with atrial septal defect (ASD), bidirectional Glenn procedure (BDG), and pulmonary insufficiency (PI) had a reduced probability of a prolonged CT (p <0.05). A similar pattern was seen in parametric analysis comparing mean CTs across lesion categories. a lower preoperative hematocrit value was associated with prolonged CTs across all lesion types (p <0.05).Conclusions. PD was common in children withm congenital cardiac lesions involving systolic flow abnormalities and was uncommon among children with lesions having diastolic abnormalities. Lower preoperative hematocrit values were associated with prolonged CTs, suggesting subclinical bleeding secondary to excessive platelet shearing.

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