Cardiothoracic Department, AHEPA University Hospital, Thessaloniki, Greece.
Perfusion. 2020 Mar;35(2):138-144. doi: 10.1177/0267659119866289. Epub 2019 Aug 5.
Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing.
A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level-guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System - HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass.
ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: -0.29; p = 0.03 for ADPtest and correlation coefficient: -0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02).
Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.
传统心肺体外循环下心外科手术会引起血小板减少和血小板功能障碍的联合作用，这与术后出血密切相关。微创体外循环已被证明可以保持凝血完整性，但其对血小板功能的影响尚不清楚。我们旨在使用即时检验（point-of-care testing）前瞻性地研究微创体外循环下心外科手术患者围手术期血小板功能。
共前瞻性招募了 57 例接受微创体外循环下心外科手术的择期患者。所有患者均采用个体化肝素管理和肝素水平指导的鱼精蛋白滴定抗凝策略，并使用专门的即时检验设备（Hemostasis Management System-PLUS；Medtronic，明尼苏达州明尼阿波利斯，美国）进行检测。使用 ROTEM 血小板（TEM International GmbH，慕尼黑，德国）进行阻抗聚集检测评估血小板功能。在手术前和体外循环后评估 ADPtest 和 TRAPtest 值。
在微创体外循环下心外科手术过程中，ADPtest 值得到了维持（58.2 ± 20 U 比 53.6 ± 21 U；p = 0.1），而 TRAPtest 值显著升高（90 ± 27 U 比 103 ± 38 U；p = 0.03）。术后 ADPtest 和 TRAPtest 值与术后出血呈负相关（相关系数：-0.29；p = 0.03 用于 ADPtest，相关系数：-0.28；p = 0.04 用于 TRAPtest）。术前使用 P2Y12 抑制剂被确定为术后 ADPtest 值低的唯一独立预测因素（OR = 15.3；p = 0.02）。
微创体外循环下心外科手术是一种血小板保护策略，有助于微创体外循环在凝血完整性方面的有益作用。
