High mortality associated with intracardiac and intrapulmonary thromboses after cardiopulmonary bypass

Ogawa, Satoshi; Richardson, James E.; Sakai, Tetsuro; Ide, Masahiro; Tanaka, Kenichi A.

doi:10.1007/s00540-011-1253-x

Cited by 36 publications

(28 citation statements)

References 71 publications

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“…The combination of extensive LV or pulmonary vascular thrombosis with acute respiratory distress syndrome would limit options for recovery, heart transplant, or transition to a long-term VAD systems. [9][10][11] Lastly, the extent of pulmonary vascular injury may be underappreciated because the pulmonary vasculature is relatively underperfused and the majority of the cardiac output is diverted away from the lungs during VA ECMO support. A chest x-ray on VA ECMO may appear fairly normal in the setting of diminished pulmonary flow only to reveal the deleterious effects of the acute pulmonary venous hypertension once pulmonary arterial flow is restored.…”

mentioning

confidence: 99%

Impella to Unload the Left Ventricle During Peripheral Extracorporeal Membrane Oxygenation

Cheng

Swartz²,

Massey³

2013

ASAIO Journal

125

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Peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) for acute cardiac failure reestablishes normal oxygen delivery and perfusion. However, VA ECMO can be limited by insufficient ventricular unloading, resulting in thrombus formation and pulmonary edema. Impella 2.5 has been used to unload the left ventricle and provide hemodynamic support during acute heart failure. We present our experience of the Impella 2.5 as an adjunct for left ventricular unloading during peripheral VA ECMO support and as a bridge for the HeartMate II left ventricular assist device (LVAD). An Impella 2.5 was placed in patients who were on peripheral VA ECMO with evidence of left ventricular distension. Patients who were candidates for heart transplant were transitioned to the HeartMate II LVAD. Five patients on VA ECMO with ventricular distension underwent Impella 2.5 implantation, resulting in a decreased left ventricular end-diastolic diameter as measured by echocardiography (7.8 ± 1.4 vs. 6.2 ± 0.8 cm, p = 0.001). Four patients were subsequently transitioned to the HeartMate II LVAD after restoration of end-organ function. Impella 2.5 is a safe means to unload the left ventricle while on peripheral VA ECMO to prevent left ventricle thrombus formation and worsening pulmonary edema in patients transitioning to a HeartMate II LVAD.

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mentioning

confidence: 99%

Impella to Unload the Left Ventricle During Peripheral Extracorporeal Membrane Oxygenation

Cheng

Swartz²,

Massey³

2013

ASAIO Journal

125

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“…Nonetheless, thrombogenicity is potentiated by the nonphysiologic hemodynamic regimen associated to blood flow within medical BRDs (2,24). Thus, a proper design of BRDs represents a key factor to be thoroughly investigated.…”

Section: Discussionmentioning

confidence: 99%

“…The extracorporeal circulation (ECC) regimen induces marked abnormalities of hemostasis, a potentially fatal complication when associated with congenital and/or acquired coagulation disorders (2). Thromboembolic events are primarily caused by the combination of two effects which contribute in enhancing platelet activation (PA) leading to thrombus formation: (i) the mechanical contribution upon the flowing corpuscular blood elements, and (ii) the contact of blood cells with the nonendothelial surfaces of the ECC circuit tubing and of the blood recirculating devices (BRDs, e.g., blood oxygenator, heat exchanger, arterial filter, etc.)…”

mentioning

confidence: 99%

On the Use of the Platelet Activity State Assay for the In Vitro Quantification of Platelet Activation in Blood Recirculating Devices for Extracorporeal Circulation

et al. 2016

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Abstract:We designed an experimental setup to characterize the thrombogenic potential associated with blood recirculating devices (BRDs) used in extracorporeal circulation (ECC). Our methodology relies on in vitro flow loop platelet recirculation experiments combined with the modified-prothrombinase platelet activity state (PAS) assay to quantify the bulk thrombin production rate of circulated platelets, which correlates to the platelet activation (PA) level. The method was applied to a commercial neonatal hollow fiber membrane oxygenator. In analogous hemodynamic environment, we compared the PA level resulting from multiple passes of platelets within devices provided with phosphorylcholine (PC)-coated and noncoated (NC) fibers to account for flow-related mechanical factors (i.e., fluid-induced shear stress) together with surface contact activation phenomena. We report for the first time that PAS assay is not significantly sensitive to the effect of material coating under clinically pertinent flow conditions (500 mL/min), while providing straightforward information on shear-mediated PA dynamics in ECC devices. Being that the latter is intimately dependent on local flow dynamics, according to our results, the rate of thrombin production as measured by the PAS assay is a valuable biochemical marker of the selective contribution of PA in BRDs induced by device design features. Thus, we recommend the use of PAS assay as a means of evaluating the effect of modification of specific device geometrical features and/or different design solutions for developing ECC devices providing flow conditions with reduced thrombogenic impact.

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“…Furthermore, no increase in vascular occlusive events was associated with tranexamic acid compared with the placebo. Thromboembolic complications seem to be rare with EACA and tranexamic acid in bleeding patients, but higher thrombotic risks are expected with DIC, pre-existing thrombophilia, oral contraceptive use, and postoperative hypercoagulability [67]. After hip and knee arthroplasties in elderly patients, there are substantial risks for deep vein thrombosis and pulmonary embolism without a proper thromboprophylaxis regimen (intermittent pneumatic compression, low-dose heparin, etc.)…”

Section: Recent Updates On Tranexamic Acidmentioning

confidence: 95%

Novel approaches in management of perioperative coagulopathy

Tanaka

Bader

Görlinger³

2014

Current Opinion in Anaesthesiology

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High mortality associated with intracardiac and intrapulmonary thromboses after cardiopulmonary bypass

Cited by 36 publications

References 71 publications

Impella to Unload the Left Ventricle During Peripheral Extracorporeal Membrane Oxygenation

Impella to Unload the Left Ventricle During Peripheral Extracorporeal Membrane Oxygenation

On the Use of the Platelet Activity State Assay for the In Vitro Quantification of Platelet Activation in Blood Recirculating Devices for Extracorporeal Circulation

Novel approaches in management of perioperative coagulopathy

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