Dynamics of Factor XIII Levels After Open Heart Surgery for Congenital Heart Defects: Do Cyanotic and Acyanotic Patients Differ?

Abstract

Cardiopulmonary bypass (CPB) reduces coagulation factor levels through hemodilution and consumption. Differences in CPB-induced alterations of factor XIII (FXIII) levels in children with cyanotic and acyanotic congenital heart defects (CHDs) are not well characterized. FXIII activity (determined by Berichrom assay), prothrombin index, activated partial thromboplastin time, and fibrinogen were measured before open heart surgery with CPB and 5 days postoperatively for children older than 3 years with acyanotic (n = 30) and cyanotic (n = 30) CHDs. The preoperative FXIII levels did not differ significantly among the children of the compared groups. The cyanotic patients showed a significantly longer duration of CPB (111.4 ± 45.8 vs 71.5 ± 33.6 min; p = 0.026) and aortic cross-clamp (68.0 ± 27.1 vs 45.4 ± 31.4 min; p = 0.034). The drop in FXIII levels after termination of CPB was more profound for the children with cyanotic CHDs (87.1 ± 13.4 to 49.1 ± 13.2 vs 81.5 ± 12.6 to 58.6 ± 11.1 %, respectively; p = 0.018). The cyanotc patients also were restored to their baseline FXIII levels later than the children with acyanotic CHDs (at 48 vs 24 h). The post-CPB dynamics of the majority of the other coagulation parameters in the compared groups of patients were similar. The cyanotic patients experienced significantly greater postoperative blood loss than the acyanotic patients (12.6 ± 4.9 vs 5.0 ± 2.1 mL/kg; p < 0.001) and were transfused with larger volumes of red blood cells (10.4 ± 6.5 vs 4.2 ± 2.5 mL/kg; p = 0.007). The decrease in FXIII levels after CPB is more profound and lasts longer in children with cyanotic CHDs than in acyanotic patients. The rational strategy of postoperative FXIII replacement therapy for these categories of patients needs to be determined.

F13A1 Gene Variant (V34L) and Residual Circulating FXIIIA Levels Predict Short- and Long-Term Mortality in Acute Myocardial Infarction after Coronary Angioplasty

“…Moreover, we demonstrated that V34L could act as a protective inherited predisposition to ischemic diseases, as well as a risk factor predisposing to intracerebral hemorrhage [ 41 ]. Finally we showed that low circulating FXIIIA levels in the first days after AMI are associated with the worst prognosis in a short-term survey [ 2 ], in line with other reports focused on different pathological contexts [ 29 , 42 , 43 ].…”

Acquired von Willebrand syndrome in congenital heart disease surgery: results from an observational case‐series

“…A postoperative transient CSVT was diagnosed in one case, but this patient also received rFVIIa, which is a known thrombogenic agent associated with increased mortality after cardiac surgery . Neonates and infants with CHD are generally at increased risk of thromboembolic complications because of a CHD‐associated imbalance between pro‐ and antithrombotic activity, abnormally low blood flow velocities and prothrombotic foreign materials . Hunt et al .…”

Coagulation Factor XIIIA (F13A1): Novel Perspectives in Treatment and Pharmacogenetics

“…The threshold level to have clinical manifestations is below 3-5% of the normal distribution. Additionally, low FXIII levels, can be caused by impaired synthesis, as can be observed following chemotherapy [8,29] and chronic liver failure [10,30], as well as in recurrent bleeding, inflammation, disseminated intravascular coagulation, burn wounds, sepsis, after open heart surgery, in inflammatory bowel disease [31][32][33][34][35][36], and also, as recently definitively demonstrated, in the acute phases of myocardial infarction [37].…”