Related Experiment Videos
[Hemostatic changes in children treated with heart surgery with cardiopulmonary bypass]
F M Silveira1, D M Lourenço, M Maluf
1Escola Paulista de Medicina, Universidade Federal de São Paulo.
Insights
Pediatric open heart surgery patients experience significant hemostatic changes, including bleeding risks. Prolonged cardiopulmonary bypass (CPB) time and lower platelet counts indicate higher bleeding risk in children.
Area of Science:
- Pediatric Cardiac Surgery
- Hemostasis and Thrombosis
- Cardiopulmonary Bypass
Context:
- Open heart surgery in children presents unique hemostatic challenges.
- Cardiopulmonary bypass (CPB) significantly impacts coagulation and fibrinolysis.
- Understanding these changes is crucial for managing postoperative bleeding.
Purpose:
- To evaluate hemostatic alterations in pediatric patients undergoing open heart surgery with CPB.
- To identify factors associated with excessive postoperative bleeding in this cohort.
Summary:
- Seventeen children were monitored for hematocrit, coagulation times (PT, aPTT), fibrinogen, platelets, factor V, and fibrinolysis (euglobulin lysis time) before, during, and after CPB.
- Significant changes included prolonged PT and aPTT, reduced fibrinogen and factor V, and shortened euglobulin lysis time.
- Six children (35%) experienced excessive bleeding, characterized by greater intraoperative platelet reduction and longer CPB duration.
Impact:
- Hemostatic changes result from both coagulation and fibrinolysis disruptions.
- Pediatric patients exhibit a higher incidence of excessive bleeding post-cardiac surgery.
- Prolonged CPB and diminished platelet counts are key indicators of bleeding risk in pediatric cardiac surgery patients.
Purpose:
We evaluated hemostasic changes in children undergoing open heart surgery with cardiopulmonary bypass (CPB).
Methods:
We studied 17 children before, during surgery, in the immediate, first and between the 4th and 7th postoperative days, measuring hematocrit, prothrombin time, activated partial thromboplastin time, fibrinogen, platelet count, factor V and euglobulin lysis time. Children were divided in those with and without excessive bleeding in the postoperative period.
Results:
We observed significant prolongation of prothrombin time and activated partial thromboplastin time, reduction of fibrinogen and factor V, and shortening of euglobulin lysis time. Six (35%) children bled excessively. Platelet count reduction was greater in the intra operative period in these cases and the duration of CPB was longer in this group.
Conclusion:
Changes in hemostasis during open heart surgery are due to coagulation cascade disorders as well as fibrinolysis. The incidence of excessive bleeding is higher in the pediatric group. Prolonged CPB time and greater reduction in platelet count differentiated both groups.