Correlations between the Circulating Level of Cell-Derived Microparticles and Surgical Variables in Heart Valve
Mehrnaz Abdolalian1, Elham Khalaf-Adeli1, Fatemeh Yari1
1Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
Background:
Cell-derived microparticles (MPs) as membrane vesicles are procoagulant. They play a role in surgical hemostasis. In this study, the correlations between the circulating level of cell-derived MPs and surgical variables in heart valve surgery were investigated.
Methods:
The present prospective case-series study was conducted in Rajaie Cardiovascular Medical and Research Center from January through March 2021. Forty patients undergoing heart valve surgery with cardiopulmonary bypass (CPB) were enrolled. Before the induction of anesthesia and 30 minutes after the administration of protamine sulfate, venous blood samples were collected. After MP isolation, the concentration of MPs was determined via the Bradford method. Flow cytometry analysis was performed to determine the MP count and phenotype. Intraoperative variables and postoperative routine coagulation tests were defined as surgical variables. Postoperative coagulopathy was defined as an activated partial thromboplastin time (aPTT) ≥48 seconds or an international normalized ratio (INR) >1.5.
Results:
The total concentration of MPs and the MP count increased significantly after surgery compared with before surgery. The postoperative concentration of MPs was positively correlated with the CPB time (P=0.030, ρ=0.40). The preoperative concentration of MPs was significantly lower in patients with higher postoperative aPTT and INR (P=0.003, P= -0.50 and P=0.020, P= -0.40, respectively). In multivariate logistic regression analysis, the preoperative MP concentration (OR, 1.00; 95% CI, 1.00 to 1.01; P=0.017) was considered a risk factor for postoperative coagulopathy.
Conclusion:
The levels of MPs, especially platelet-derived MPs, rose after surgery, in correlation with the CPB time. Given the role of MPs in the induction of coagulation and inflammation, they can be considered therapeutic goals for preventing postoperative complications. In addition, the preoperative levels of MPs are a risk factor for predicting the occurrence of postoperative coagulopathy in heart valve surgery.
Insights
Cell-derived microparticles (MPs) increase after heart valve surgery, correlating with cardiopulmonary bypass time. Preoperative MP levels predict postoperative coagulopathy, suggesting MPs as potential therapeutic targets.
Area of Science:
- Cardiovascular Research
- Hemostasis and Thrombosis
- Biomedical Engineering
Background:
- Cell-derived microparticles (MPs) are procoagulant membrane vesicles involved in surgical hemostasis.
- Investigated correlations between circulating MPs and surgical variables in heart valve surgery.
Purpose of the Study:
- To investigate the relationship between cell-derived microparticle levels and surgical variables in patients undergoing heart valve surgery.
- To determine if preoperative microparticle levels can predict postoperative coagulopathy.
Main Methods:
- Prospective case-series study of 40 patients undergoing heart valve surgery with cardiopulmonary bypass (CPB).
- Blood samples collected pre-anesthesia and post-protamine sulfate for MP isolation and quantification (Bradford method, flow cytometry).
- Surgical variables included intraoperative data and postoperative coagulation tests (aPTT, INR); coagulopathy defined as aPTT ≥48s or INR >1.5.
Main Results:
- Total MP concentration and count significantly increased post-surgery.
- Postoperative MP concentration positively correlated with CPB time (P=0.030, ρ=0.40).
- Preoperative MP concentration was lower in patients with higher postoperative aPTT and INR (P=0.003, P=-0.50 and P=0.020, P=-0.40, respectively).
- Preoperative MP concentration identified as a risk factor for postoperative coagulopathy (OR, 1.00; 95% CI, 1.00-1.01; P=0.017).
Conclusions:
- MP levels, particularly platelet-derived MPs, rise post-surgery, correlating with CPB duration.
- MPs' role in coagulation and inflammation suggests potential as therapeutic targets for preventing postoperative complications.
- Preoperative MP levels are a significant risk factor for predicting postoperative coagulopathy in heart valve surgery.
