Department of Surgery, 12264University of Maryland School of Medicine, Baltimore, MD, USA.
Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, MD, USA.
Clin Appl Thromb Hemost. 2021 Jan-Dec;27:1076029620982374. doi: 10.1177/1076029620982374.
Mechanically assisted circulation (MAC) sustains the blood circulation in the body of a patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) or on ventricular assistance with a ventricular assist device (VAD) or on extracorporeal membrane oxygenation (ECMO) with a pump-oxygenator system. While MAC provides short-term (days to weeks) support and long-term (months to years) for the heart and/or lungs, the blood is inevitably exposed to non-physiological shear stress (NPSS) due to mechanical pumping action and in contact with artificial surfaces. NPSS is well known to cause blood damage and functional alterations of blood cells. In this review, we discussed shear-induced platelet adhesion, platelet aggregation, platelet receptor shedding, and platelet apoptosis, shear-induced acquired von Willebrand syndrome (AVWS), shear-induced hemolysis and microparticle formation during MAC. These alterations are associated with perioperative bleeding and thrombotic events, morbidity and mortality, and quality of life in MCS patients. Understanding the mechanism of shear-induce hemostatic disorders will help us develop low-shear-stress devices and select more effective treatments for better clinical outcomes.
机械循环辅助 (MAC) 通过心肺旁路 (CPB) 为接受心脏手术的患者、心室辅助装置 (VAD) 为心室辅助或体外膜氧合 (ECMO) 与泵-氧合器系统为患者的血液循环提供短期（数天至数周）和长期（数月至数年）支持。虽然 MAC 为心脏和/或肺提供了短期（数天至数周）和长期（数月至数年）支持，但由于机械泵送作用，血液不可避免地会暴露于非生理剪切应力 (NPSS) 并与人工表面接触。众所周知，NPSS 会导致血细胞损伤和功能改变。在这篇综述中，我们讨论了剪切诱导的血小板黏附、血小板聚集、血小板受体脱落和血小板凋亡、MAC 期间剪切诱导获得性血管性血友病综合征 (AVWS)、剪切诱导的溶血和微颗粒形成。这些改变与围手术期出血和血栓事件、发病率和死亡率以及 MCS 患者的生活质量有关。了解剪切诱导止血紊乱的机制将有助于我们开发低剪切应力装置，并选择更有效的治疗方法以获得更好的临床结果。
