High flow velocity through congenital cardiac lesions predicts preoperative platelet dysfunction

M. Mujeeb Zubair, Alan (Roger) Hohimer, David K. Bailly, Ashok Muralidaran, Erin Madriago, M. Haseeb Zubair, Michael R. Lasarev, Stephen M. Langley

Research output: Contribution to journalArticle

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Abstract

Background Platelet dysfunction resulting from abnormal fluid shear stress has been reported in adults with aortic stenosis. Blood flowing through a congenital heart defect at greater than normal velocity is subjected to increased shear stress. The primary aim was to determine whether peak flow velocity through congenital cardiac lesions predicts preoperative platelet dysfunction. Methods The charts of 402 patients who underwent cardiopulmonary bypass and had preoperative platelet function analysis were evaluated. Platelet dysfunction was measured as a prolonged closure time (CT) in seconds with a platelet function analyzer. Echocardiography was used to determine peak velocity. The relationship between peak velocity and CT was analyzed using linear regression and Kaplan-Meier estimation. Results The distribution of peak velocity was bimodal. The mean velocity of the lower group was 1.9 m/second and the higher group was 4.2 m/second. Univariate analysis showed age, weight, peak velocity, hematocrit, and Risk Adjustment for Congenital Heart Surgery score to be associated with prolonged CT. Using multivariable analysis, prolonged CT was significantly associated with peak velocity (p <0.001). For each 1m/second increase in peak velocity the CT increased by over 9 seconds (p <0.001). In addition, a median CT increase of more than 6 seconds was also associated with a 5 percentage point drop in hematocrit (p = 0.04). Conclusions Platelet dysfunction is associated with high blood flow velocity through congenital cardiac lesions. Lower preoperative hematocrit was associated with prolonged CT, which may suggest subclinical bleeding secondary to platelet dysfunction.

Original languageEnglish (US)
Pages (from-to)1379-1385
Number of pages7
JournalAnnals of Thoracic Surgery
Volume99
Issue number4
DOIs
StatePublished - Apr 1 2015

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Blood Platelets
Hematocrit
Risk Adjustment
Blood Flow Velocity
Congenital Heart Defects
Aortic Valve Stenosis
Cardiopulmonary Bypass
Thoracic Surgery
Echocardiography
Linear Models
Hemorrhage
Weights and Measures

ASJC Scopus subject areas

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

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High flow velocity through congenital cardiac lesions predicts preoperative platelet dysfunction. / Zubair, M. Mujeeb; Hohimer, Alan (Roger); Bailly, David K.; Muralidaran, Ashok; Madriago, Erin; Zubair, M. Haseeb; Lasarev, Michael R.; Langley, Stephen M.

In: Annals of Thoracic Surgery, Vol. 99, No. 4, 01.04.2015, p. 1379-1385.

Research output: Contribution to journalArticle

Zubair, M. Mujeeb ; Hohimer, Alan (Roger) ; Bailly, David K. ; Muralidaran, Ashok ; Madriago, Erin ; Zubair, M. Haseeb ; Lasarev, Michael R. ; Langley, Stephen M. / High flow velocity through congenital cardiac lesions predicts preoperative platelet dysfunction. In: Annals of Thoracic Surgery. 2015 ; Vol. 99, No. 4. pp. 1379-1385.
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AU - Madriago, Erin

AU - Zubair, M. Haseeb

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N2 - Background Platelet dysfunction resulting from abnormal fluid shear stress has been reported in adults with aortic stenosis. Blood flowing through a congenital heart defect at greater than normal velocity is subjected to increased shear stress. The primary aim was to determine whether peak flow velocity through congenital cardiac lesions predicts preoperative platelet dysfunction. Methods The charts of 402 patients who underwent cardiopulmonary bypass and had preoperative platelet function analysis were evaluated. Platelet dysfunction was measured as a prolonged closure time (CT) in seconds with a platelet function analyzer. Echocardiography was used to determine peak velocity. The relationship between peak velocity and CT was analyzed using linear regression and Kaplan-Meier estimation. Results The distribution of peak velocity was bimodal. The mean velocity of the lower group was 1.9 m/second and the higher group was 4.2 m/second. Univariate analysis showed age, weight, peak velocity, hematocrit, and Risk Adjustment for Congenital Heart Surgery score to be associated with prolonged CT. Using multivariable analysis, prolonged CT was significantly associated with peak velocity (p <0.001). For each 1m/second increase in peak velocity the CT increased by over 9 seconds (p <0.001). In addition, a median CT increase of more than 6 seconds was also associated with a 5 percentage point drop in hematocrit (p = 0.04). Conclusions Platelet dysfunction is associated with high blood flow velocity through congenital cardiac lesions. Lower preoperative hematocrit was associated with prolonged CT, which may suggest subclinical bleeding secondary to platelet dysfunction.

AB - Background Platelet dysfunction resulting from abnormal fluid shear stress has been reported in adults with aortic stenosis. Blood flowing through a congenital heart defect at greater than normal velocity is subjected to increased shear stress. The primary aim was to determine whether peak flow velocity through congenital cardiac lesions predicts preoperative platelet dysfunction. Methods The charts of 402 patients who underwent cardiopulmonary bypass and had preoperative platelet function analysis were evaluated. Platelet dysfunction was measured as a prolonged closure time (CT) in seconds with a platelet function analyzer. Echocardiography was used to determine peak velocity. The relationship between peak velocity and CT was analyzed using linear regression and Kaplan-Meier estimation. Results The distribution of peak velocity was bimodal. The mean velocity of the lower group was 1.9 m/second and the higher group was 4.2 m/second. Univariate analysis showed age, weight, peak velocity, hematocrit, and Risk Adjustment for Congenital Heart Surgery score to be associated with prolonged CT. Using multivariable analysis, prolonged CT was significantly associated with peak velocity (p <0.001). For each 1m/second increase in peak velocity the CT increased by over 9 seconds (p <0.001). In addition, a median CT increase of more than 6 seconds was also associated with a 5 percentage point drop in hematocrit (p = 0.04). Conclusions Platelet dysfunction is associated with high blood flow velocity through congenital cardiac lesions. Lower preoperative hematocrit was associated with prolonged CT, which may suggest subclinical bleeding secondary to platelet dysfunction.

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