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 language | English (US) |
|---|---|
| Pages (from-to) | 1379-1385 |
| Number of pages | 7 |
| Journal | Annals of Thoracic Surgery |
| Volume | 99 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2015 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
- Pulmonary and Respiratory Medicine
- Medicine(all)
Cite this
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 journal › Article
}
TY - JOUR
T1 - High flow velocity through congenital cardiac lesions predicts preoperative platelet dysfunction
AU - Zubair, M. Mujeeb
AU - Hohimer, Alan (Roger)
AU - Bailly, David K.
AU - Muralidaran, Ashok
AU - Madriago, Erin
AU - Zubair, M. Haseeb
AU - Lasarev, Michael R.
AU - Langley, Stephen M.
PY - 2015/4/1
Y1 - 2015/4/1
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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U2 - 10.1016/j.athoracsur.2014.10.039
DO - 10.1016/j.athoracsur.2014.10.039
M3 - Article
VL - 99
SP - 1379
EP - 1385
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 4
ER -