Vol. 19 No. 4 (2015)
ANESTHESIOLOGY & RESUSCITATION

Characteristics of hemostasis system and hemorrhagic syndrome in infants with congenital heart disease in operations with cardiopulmonary bypass

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  • N. Leonov,
  • A. Karas'kov,
  • O. Strunin,
  • Yu. Gorbatykh,
  • N. Karmadonova
N. Leonov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
A. Karas'kov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
O. Strunin
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
Yu. Gorbatykh
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
N. Karmadonova
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2015-4-79-90

Published 2016-01-11

Keywords

  • newborn,
  • congenital heart disease,
  • hemorrhage,
  • hemostasis,
  • coagulopathy,
  • thromboelastography,
  • multiple organ failure
    • ...More
    Less

How to Cite

Leonov, N., Karas’kov, A., Strunin, O., Gorbatykh, Y., & Karmadonova, N. (2016). Characteristics of hemostasis system and hemorrhagic syndrome in infants with congenital heart disease in operations with cardiopulmonary bypass. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 19(4), 79–90. https://doi.org/10.21688/1681-3472-2015-4-79-90

Copyright (c) 2016 Leonov N.P., Karas'kov A.M., Strunin O.V., Gorbatykh Yu.N., Karmadonova N.A.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

97 neonates were included in this prospective observational study. While using the exclusion criteria, two groups without demographic differences were formed: the first group included 35 patients with blood loss greater than 10 ml/kg in the first 4 hours postoperatively, the second one consisted of 46 patients who did not have such blood loss. Hemostatic standard tests and thromboelastography were performed before surgery, immediately after surgery and 24 hours after it. As a result, a detailed description of the changes of hemostasis in the perioperative period in newborns with CHD was developed. It was found out that significant postoperative bleeding increases the incidence of coagulopathy, resuscitation after surgery, duration of mechanical ventilation, length of stay at ICU and 30-day mortality. It is confirmed that the main pathogenetic mechanisms of increased bleeding in the first hours after the operation are due to cardiopulmonary bypass coagulopathy, the dynamics and implications of which are documented in our study. Also established are prognostic clinical and laboratory predictors of coagulopathy associated with severe multiple organ failure.

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References

  1. Andrew M., Paes B., Milner R., Johnston M., Mitchell L., Tollefsen D.M. Powers P. Development of the human coagulation system in the full-term infant // Blood. 1987. Vol. 70. № 1. P. 165–72.
  2. Andrew M., Paes B., Milner R., Johnston M., Mitchell L., Tollefsen D.M. Castle V, Powers P. Development of the human coagulation system in the healthy premature infant // Blood. 1988. Vol. 72. № 5. P. 1651–7.
  3. Kuhle S., Male C., Mitchell L. Developmental hemostasis: pro- and anticoagulant systems during childhood // Semin. Thromb. Hemost. 2003. Vol. 29. № 4. P. 329–38.
  4. Шабалов Н.П., Иванов Д.О., Шабалова Н.Н. Гемостаз в динамике первой недели жизни как отражение механизмов адаптации к внеутробной жизни новорожденного // Педиатрия. 2000. № 3. С. 84–91.
  5. Monagle Р., Ignjatovic V., Savoiaс H. Hemostasis in neonates and children: pitfalls and dilemmas // Blood Rev. 2010. Vol. 24. № 2. P. 63–8.
  6. Hezard N., Potron G., Schlegel N., Amory C., Leroux B., Nguyen P. Unexpected persistence of platelet hyporeactivity beyond the neonatal period: a flow cytometric study in neonates, infants and older children // Thromb. Haemost. 2003. Vol. 90. № 1. P. 116–23.
  7. Andrew M., Paes B., Johnston M. Development of the hemostatic system in the neonate and young infant // Am. J. Pediatr. Hematol. Oncol. 1990. Vol. 12. № 1. P. 95–104.
  8. Чупрова А. В. Система неонатального гемостаза в норме и при патологии (научный обзор) // Бюллетень СО РАМН. 2005. № 4. С. 13–9.
  9. Дорофеева Е.И., Демихов В.Г., Демихова Е.В., Скобин В.Б., Жаров И.А., Морщакова Е.Ф. Особенности гемостаза у новорожденных детей // Тромбоз, гемостаз и реология. 2013. Т. 53. № 1. С. 44.
  10. Kontras S.B., Sirak H.D., Newton W.A Jr. Hematologic abnormalities in children with congenital heart disease // JAMA. 1966. Vol. 195. № 8. P. 611–5.
  11. Henriksson P., Varendh G., Lundstrom NR. Haemostatic defects in cyanotic congenital heart disease // Br. Heart J. 1979. Vol. 41. № 1. P. 23–7.
  12. Colon-Otero G., Gilchrist G.S., Holcomb G.R., Ilstrup D.M., Bowie E.J. Preoperative evaluation of hemostasis in patients with congenital heart disease // Mayo Clin. Proc. 1987. Vol. 62. № 5. P. 379–85.
  13. Чарная М.А. Патогенез нарушений системы гемостаза при кардиохирургических операциях: Автореф. дис. д-ра биол. наук. М, 2007. 42 с.
  14. Исаева А.М. Причины и характер нарушений тромбоцитарного звена гемостаза у больных оперированных на сердце в условиях искусственного кровообращения. Автореф. канд. биол. наук, М. 2006. 31 с.
  15. Чарная М.А., Морозов Ю.А., Гладышева В.Г., Крапивкин И.А. Влияние технических характеристик экстракорпоральных контуров на тромбоцитарное звено гемостаза, систему фибринолиза и развитие гемолиза // Патология кровообращения и кардиохирургия. 2005. № 3. С. 34–7.
  16. Gando S. Microvascular thrombosis and multiple organ dysfunction syndrome // Crit. Care Med. 2010. Vol. 38. № 2. P. 35–42.
  17. Petaja J., Peltola K. Venous thrombosis in pediatric cardiac surgery // J. Cardiothorac. Vasc. Anesth. 1997. Vol. 11. № 7. P. 889–94.
  18. Guay J., de Moerloose P., Lasne D. Minimizing perioperative blood loss and transfusions in children // Can. J. Anesth. 2006. Vol. 53. № 6. P. 59–67.
  19. Фуражков Д.А., Свалов А.И., Захаров Е.В., Булдакова Т.Л., Левит А.Л., Казанцев К.Б. Методы ультрафильтрации как способ регуляции гидробаланса при коррекции транспозиции магистральных артерий у новорожденных детей // Патология кровообращения и кардиохирургия. 2014. № 3. С. 24–6.
  20. Gando S., Iba T., Eguchi Y., Ohtomo Y., Okamoto K., Koseki K., Mayumi T., Murata A., Ikeda T., Ishikura H., Ueyama M., Ogura H., Kushimoto S., Saitoh D., Endo S., Shimazaki S. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria // Crit. Care Med. 2006. Vol. 34. № 3. P. 625–31.
  21. Leteurtre S., Martinot A., Duhamel A., Gauvin F., Grandbastien B., Nam T.V., Proulx F., Lacroix J., Leclerc F. Development of a pediatric multiple organ dysfunction score: use of two strategies // Med. Decis. Making. 1999. Vol. 19. № 4. P. 399–410.
  22. Долгов В.В., Свирин П.В. Лабораторная диагностика нарушений гемостаза. М.-Тверь: Триада, 2005. 227 с.
  23. Edwards R.M., Naik-Mathuria B.J., Gay A.N., Olutoye O.O., Teruya J. Parameters of Thromboelastography in Healthy Newborns // Am. J. Clin. Pathol. 2008. Vol. 130. P. 99–102.
  24. Ranucci M., Carlucci C., Isgrò G., Boncilli A., De Benedetti D., De la Torre T., Brozzi S., Frigiola A.. Duration of red blood cell storage and outcomes in pediatric cardiac surgery: an association found for pump prime blood // Crit. Care. 2009. Vol. 13. № 6. P. R207.
  25. Соловьев Г.М., Супрунов М.В., Попов Л.В. Кровопотеря и гемостаз в кардиохирургии // Патология кровообращения и кардиохирургия. 2000. № 1–2. С. 50–52.
  26. Miller B.E., Guzzetta N.A., Tosone S.R., Levy J.H. Rapid evaluation of coagulopathies after cardiopulmonary bypass in children using modified thromboelastography // Anesth. Analg. 2000. Vol. 90. P. 1324–30.
  27. Waldén K., Jeppsson A., Nasic S., Backlund E., Karlsson M. Low preoperative fibrinogen plasma concentration is associated with excessive bleeding after cardiac operations // Ann. Thorac. Surg. 2014. Vol. 97. № 4. P. 1199–1206.
  28. Moganasundram S., Hunt B.J., Sykes K., Holton F., Parmar K., Durward A., Murdoch I.A., Austin C., Anderson D., Tibby S.M. The relationship among thromboelastography, hemostatic variables, and bleeding after cardiopulmonary bypass surgery in children // Anesth. Analg. 2010. Vol. 110. № 4. P. 995–1002.
  29. Orlov D., McCluskey SA., Selby R., Yip P., Pendergrast J., Karkouti K. Platelet dysfunction as measured by a point-of-care monitor is an independent predictor of high blood loss in cardiac surgery // Anesth. Analg. 2014. Vol. 118. № 2. P. 257–63.