Oishi Hisashi, Okada Yoshinori, Suzuki Yamato, Hirama Takashi, Ejima Yutaka, Fujimaki Shin-Ichi, Sugawara Shingo, Okubo Noriyuki, Horiuchi Hisanori
Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
Department of Anesthesiology, Tohoku University Hospital, Sendai, Japan.
J Thorac Dis. 2023 Aug 31;15(8):4262-4272. doi: 10.21037/jtd-23-275. Epub 2023 Jul 28.
von Willebrand factors (vWFs), hemostatic factors, are produced as large multimers and are shear stress-dependently cleaved to become the appropriate size. A reduction in vWF large multimers develops in various conditions including the use of extracorporeal life support, which can cause excessive-high shear stress in the blood flow and result in hemostatic disorders. The objective of this prospective study was to investigate the impact of venovenous extracorporeal membrane oxygenation (VV ECMO) use on the status of vWF large multimers and hemostatic disorders during single lung transplantation (SLT).
We prospectively enrolled 12 patients who underwent SLT at our center. Among them, seven patients were supported by VV ECMO intraoperatively (ECMO group) and the remaining five patients underwent SLT without ECMO support (control group). The vWF large multimer index (%) was defined as the ratio of the large multimer proportion in total vWF (vWF large multimer ratio) derived from a patient's plasma to that from standard human plasma.
The vWF large multimer index at the end of the surgery was significantly lower in the ECMO group than in the control group (112.6% 75.8%, respectively; P<0.05). The intraoperative blood loss and the amounts of intraoperative transfusion products in the ECMO group tended to be greater than those in the control group; however, the differences were not significant.
During SLT, the use of VV ECMO caused a decrease in the vWF large multimer index. The short duration of time of VV ECMO use in our study did not significantly affect the intra- and postoperative outcomes including blood loss, blood transfusion, and re-exploration thoracotomy for bleeding. Nevertheless, to comprehensively evaluate the actual influence of this decrease in the vWF large multimer index on intra- and postoperative outcomes, a multicenter larger-scale study is warranted.
血管性血友病因子（vWF）是一种止血因子，以大的多聚体形式产生，并在剪切应力作用下被切割成合适大小。在包括使用体外生命支持等各种情况下，vWF大的多聚体会减少，这会导致血流中过高的剪切应力，并引发止血障碍。这项前瞻性研究的目的是探讨静脉-静脉体外膜肺氧合（VV ECMO）在单肺移植（SLT）过程中对vWF大的多聚体状态及止血障碍的影响。
我们前瞻性地纳入了12例在本中心接受SLT的患者。其中，7例患者术中接受VV ECMO支持（ECMO组），其余5例患者在无ECMO支持的情况下接受SLT（对照组）。vWF大的多聚体指数（%）定义为患者血浆中总vWF（vWF大的多聚体比例）中大分子多聚体比例与标准人血浆中该比例的比值。
手术结束时，ECMO组的vWF大的多聚体指数显著低于对照组（分别为112.6%和75.8%；P<0.05）。ECMO组术中失血量和术中输注产品量往往高于对照组；然而，差异无统计学意义。
在SLT过程中，使用VV ECMO导致vWF大的多聚体指数下降。在我们的研究中，VV ECMO使用时间较短，对包括失血、输血和因出血进行再次开胸手术在内的术中及术后结果没有显著影响。尽管如此，为了全面评估vWF大的多聚体指数下降对术中及术后结果的实际影响，有必要开展多中心大规模研究。
