Meyer Andrew D, Rishmawi Anjana, Elkhalili Alia, Rupert David, Walker Joshua, Calhoon John, Cap Andrew P, Kane Lauren
Division of Critical Care, Department of Pediatrics, Long School of Medicine, University of Texas Health Science Center, San Antonio, TX.
Department of Organ Support & Automated Technologies, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX.
Crit Care Explor. 2025 Mar 31;7(4):e1236. doi: 10.1097/CCE.0000000000001236. eCollection 2025 Apr 1.
Over 10% of children develop thrombosis after cardiac surgery for congenital heart disease. Children with a single ventricle physiology have the highest risk of thrombosis associated with increased length of the postoperative stay, neurologic complications, and mortality. To decrease these complications, research is needed to understand the mechanisms that promote cardiopulmonary bypass (CPB) surgery-induced thrombin generation and clot formation.
The objective of this pilot observational study was to measure the generation of prothrombotic microvesicles (MVs) and thrombin generation in 21 children collected 5 minutes after initiation of CPB, at the end of CPB, upon arrival in the pediatric congenital cardiac unit (PCCU), and 20 to 24 hours after arrival in the PCCU.
DESIGN, SETTING, AND PARTICIPANTS: An observational pilot study measured platelet and leukocyte MV, platelet aggregation, coagulation, and thrombin generation in 21 children undergoing CPB surgery. The study setting was a tertiary pediatric hospital. Inclusion criteria included age between birth to 5 years and weight on the day of surgery greater than three kilograms.
Bleeding outcomes were measured by chest tube output and thrombotic outcomes were measured by surveillance ultrasound. Laboratory outcomes of prothrombotic MVs and thrombin generation were measured by high-resolution flow cytometry and calibrated automated thrombogram, respectively.
Time on CPB correlated with a significant increase in WBCs and phosphatidylserine-expressing MVs. Children with single ventricle physiology had increased levels of prothrombotic MVs (p = 0.017), platelet aggregation, peak thrombin (p = 0.019), and d-dimer (p = 0.029) upon arrival to the ICU compared with children with a dual ventricle. Only single ventricle children had a positive correlation between generation of platelet MV with peak thrombin (p = 0.010).
Larger prospective studies are needed to determine if prothrombotic MVs can predict children with congenital heart disease at risk for thrombotic events.
超过10%的儿童在先天性心脏病心脏手术后会发生血栓形成。单心室生理的儿童发生血栓形成的风险最高，这与术后住院时间延长、神经系统并发症及死亡率增加相关。为减少这些并发症，需要开展研究以了解促进体外循环（CPB）手术诱导凝血酶生成和血栓形成的机制。
这项初步观察性研究的目的是测量21名儿童在CPB开始5分钟后、CPB结束时、抵达小儿先天性心脏病监护病房（PCCU）时以及抵达PCCU后20至24小时的促血栓形成微泡（MVs）生成情况和凝血酶生成情况。
设计、地点和参与者：一项观察性初步研究测量了21名接受CPB手术儿童的血小板和白细胞MV、血小板聚集、凝血及凝血酶生成情况。研究地点为一家三级儿科医院。纳入标准包括出生至5岁的年龄以及手术当天体重超过3千克。
出血结局通过胸管引流量来测量，血栓形成结局通过超声监测来测量。促血栓形成MV和凝血酶生成的实验室结局分别通过高分辨率流式细胞术和校准自动血栓图来测量。
CPB时间与白细胞和表达磷脂酰丝氨酸的MV显著增加相关。与双心室儿童相比，单心室生理的儿童在抵达重症监护病房时促血栓形成MV水平升高（p = 0.017）、血小板聚集、凝血酶峰值（p = 0.019）及D-二聚体（p = 0.029）升高。只有单心室儿童的血小板MV生成与凝血酶峰值之间存在正相关（p = 0.010）。
需要开展更大规模的前瞻性研究，以确定促血栓形成MV是否能够预测有血栓形成事件风险的先天性心脏病儿童。
