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Microvascular reactivity measured by vascular occlusion test is an independent predictor for postoperative bleeding in patients undergoing cardiac surgery

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Abstract

The purpose of the study is to investigate the relationship between microvascular reactivity and postoperative bleeding in cardiac surgery. The authors retrospectively analyzed a prospectively collected registry of cardiac surgery patients. Data from 154 patients enrolled in the registry were analyzed. A linear mixed model was performed to evaluate the association between the amount of postoperative chest tube output (CTO, milliliter, repeatedly measured at 0–8, 8–24, and 24–48 h) and tissue oxygen saturation (StO2) recovery slope (%/s) measured by vascular occlusion test (VOT) at skin closure. A logistic regression was carried out to see the relationship between StO2 recovery slope and packed red blood cell (PRBC) transfusion during the 48-h postoperative period. In the multivariable adjusted model, the effect of StO2 recovery slope on postoperative CTO (log-transformed) was statistically significant, and the degree of StO2 recovery slope was inversely related to the amount of CTO (exp(estimate) = 0.935; exp(95% CI) 0.881–0.992; p = 0.027). StO2 recovery slope was also inversely associated with postoperative PRBC transfusion possibility (OR = 0.795; 95% CI 0.633–0.998; p = 0.048). Microvascular reactivity measured by VOT is independently and inversely associated with postoperative bleeding in patients undergoing cardiac surgery.

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References

  1. Parry GC, Mackman N. NF-kappaB mediated transcription in human monocytic cells and endothelial cells. Trends Cardiovasc Med. 1998;8:138–142.

    Article  CAS  PubMed  Google Scholar 

  2. Lindmark E, Tenno T, Siegbahn A. Role of platelet P-selectin and CD40 ligand in the induction of monocytic tissue factor expression. Arterioscler Thromb Vasc Biol. 2000;20:2322–2328.

    Article  CAS  PubMed  Google Scholar 

  3. Devaraj S, Xu DY, Jialal I. C-reactive protein increases plasminogen activator inhibitor-1 expression and activity in human aortic endothelial cells: implications for the metabolic syndrome and atherothrombosis. Circulation. 2003;107:398–404.

    Article  CAS  PubMed  Google Scholar 

  4. Ten VS, Pinsky DJ. Endothelial response to hypoxia: physiologic adaptation and pathologic dysfunction. Curr Opin Crit Care. 2002;8:242–50.

    Article  PubMed  Google Scholar 

  5. De Blasi RA, Palmisani S, Alampi D, Mercieri M, Romano R, Collini S, Pinto G. Microvascular dysfunction and skeletal muscle oxygenation assessed by phase-modulation near-infrared spectroscopy in patients with septic shock. Intensive Care Med. 2005;31:1661–8.

    Article  PubMed  Google Scholar 

  6. Lima A, van Bommel J, Jansen TC, Ince C, Bakker J. Low tissue oxygen saturation at the end of early goal-directed therapy is associated with worse outcome in critically ill patients. Crit Care. 2009;13(Suppl 5):S13.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lima A, van Bommel J, Sikorska K, van Genderen M, Klijn E, Lesaffre E, Ince C, Bakker J. The relation of near-infrared spectroscopy with changes in peripheral circulation in critically ill patients. Crit Care Med. 2011;39:1649–54.

    Article  PubMed  Google Scholar 

  8. Shapiro NI, Arnold R, Sherwin R, et al. The association of near-infrared spectroscopy-derived tissue oxygenation measurements with sepsis syndromes, organ dysfunction and mortality in emergency department patients with sepsis. Crit Care. 2011;15:R223.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cohn SM, Nathens AB, Moore FA, et al. Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. J Trauma. 2007;62:44–54.

    Article  PubMed  Google Scholar 

  10. Kim TK, Cho YJ, Min JJ, Murkin JM, Bahk JH, Hong DM, Jeon Y. Microvascular reactivity and clinical outcomes in cardiac surgery. Crit Care. 2015;19:316.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kim TK, Cho YJ, Min JJ, Murkin JM, Bahk JH, Hong DM, Jeon Y. Tissue microcirculation measured by vascular occlusion test during anesthesia induction. J Clin Monit Comput. 2016;30:41–50.

    Article  PubMed  Google Scholar 

  12. Skarda DE, Mulier KE, Myers DE, Taylor JH, Beilman GJ. Dynamic near-infrared spectroscopy measurements in patients with severe sepsis. Shock. 2007;27:348–53.

    Article  CAS  PubMed  Google Scholar 

  13. Doerschug KC, Delsing AS, Schmidt GA, Haynes WG. Impairments in microvascular reactivity are related to organ failure in human sepsis. Am J Physiol Heart Circ Physiol. 2007;293:H1065–H1071.

    Article  CAS  PubMed  Google Scholar 

  14. Zipperle J, Schlimp CJ, Holnthoner W, Husa AM, Nurnberger S, Redl H, Schochl H. A novel coagulation assay incorporating adherent endothelial cells in thromboelastometry. Thromb Haemost. 2013;109:869–77.

    Article  CAS  PubMed  Google Scholar 

  15. Reinhofer M, Brauer M, Franke U, Barz D, Marx G, Losche W. The value of rotation thromboelastometry to monitor disturbed perioperative haemostasis and bleeding risk in patients with cardiopulmonary bypass. Blood Coagul Fibrinolysis. 2008;19:212–9.

    Article  PubMed  Google Scholar 

  16. Whiting D, DiNardo JA. TEG and ROTEM: technology and clinical applications. Am J Hematol. 2014;89:228–32.

    Article  CAS  PubMed  Google Scholar 

  17. Ji SM, Kim SH, Nam JS, Yun HJ, Choi JH, Lee EH, Choi IC (2015) Predictive value of rotational thromboelastometry during cardiopulmonary bypass for thrombocytopenia and hypofibrinogenemia after weaning of cardiopulmonary bypass. Kor. J Anesthesiol 68:241–248.

    Article  Google Scholar 

  18. Girdauskas E, Kempfert J, Kuntze T, Borger MA, Enders J, Fassl J, Falk V, Mohr FW. Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: a prospective, randomized trial. J Thorac Cardiovasc Surg. 2010;140:1117–24.

    Article  PubMed  Google Scholar 

  19. Weber CF, Gorlinger K, Meininger D, Herrmann E, Bingold T, Moritz A, Cohn LH, Zacharowski K. Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology. 2012;117:531–47.

    Article  PubMed  Google Scholar 

  20. Wikkelso A, Wetterslev J, Moller AM, Afshari A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev. 2016. doi:10.1002/14651858.CD007871.pub3.

    PubMed  Google Scholar 

  21. Lowenberg EC, Meijers JC, Levi M. Platelet-vessel wall interaction in health and disease. Neth J Med. 2010;68:242–51.

    CAS  PubMed  Google Scholar 

  22. van Hinsbergh VW. Endothelium—role in regulation of coagulation and inflammation. Semin Immunopathol. 2012;34:93–106.

    Article  PubMed  Google Scholar 

  23. Yan SF, Mackman N, Kisiel W, Stern DM, Pinsky DJ. Hypoxia/hypoxemia-induced activation of the procoagulant pathways and the pathogenesis of ischemia-associated thrombosis. Arterioscler Thromb Vasc Biol. 1999;19:2029–35.

    Article  CAS  PubMed  Google Scholar 

  24. Christensen MC, Dziewior F, Kempel A, von Heymann C. Increased chest tube drainage is independently associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth. 2012;26:46–51.

    Article  PubMed  Google Scholar 

  25. Stone GW, Clayton TC, Mehran R, Dangas G, Parise H, Fahy M, Pocock SJ. Impact of major bleeding and blood transfusions after cardiac surgery: analysis from the Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial. Am Heart J. 2012;163:522–9.

    Article  PubMed  Google Scholar 

  26. Koch CG, Li L, Duncan AI, Mihaljevic T, Loop FD, Starr NJ, Blackstone EH. Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg. 2006;81:1650–7.

    Article  PubMed  Google Scholar 

  27. Surgenor SD, Kramer RS, Olmstead EM, et al. The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery. Anesth Analg. 2009;108:1741–6.

    Article  PubMed  Google Scholar 

  28. Herwaldt LA, Swartzendruber SK, Edmond MB, Embrey RP, Wilkerson KR, Wenzel RP, Perl TM. The epidemiology of hemorrhage related to cardiothoracic operations. Infect Control Hosp Epidemiol. 1998;19:9–16.

    Article  CAS  PubMed  Google Scholar 

  29. Winkelmayer WC, Levin R, Avorn J. Chronic kidney disease as a risk factor for bleeding complications after coronary artery bypass surgery. Am J Kidney Dis. 2003;41:84–9.

    Article  PubMed  Google Scholar 

  30. Chakravarthy M, Muniraj G, Patil S, Suryaprakash S, Mitra S, Shivalingappa B. A randomized prospective analysis of alteration of hemostatic function in patients receiving tranexamic acid and hydroxyethyl starch (130/0.4) undergoing off pump coronary artery bypass surgery. Ann Card Anaesth. 2012;15:105–10.

    Article  PubMed  Google Scholar 

  31. Carroll RC, Chavez JJ, Snider CC, Meyer DS, Muenchen RA. Correlation of perioperative platelet function and coagulation tests with bleeding after cardiopulmonary bypass surgery. J Lab Clin Med. 2006;147:197–204.

    Article  CAS  PubMed  Google Scholar 

  32. Ferraris VA, Gildengorin V. Predictors of excessive blood use after coronary artery bypass grafting. A multivariate analysis. J Thorac Cardiovasc Surg. 1989;98:492–7.

    CAS  PubMed  Google Scholar 

  33. Hecht-Dolnik M, Barkan H, Taharka A, Loftus J. Hetastarch increases the risk of bleeding complications in patients after off-pump coronary bypass surgery: a randomized clinical trial. J Thorac Cardiovasc Surg. 2009;138:703–11.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno, Seoul, 03080, Republic of Korea

    Karam Nam, Hyung-Min Oh, Chang-Hoon Koo, Tae Kyong Kim, Youn Joung Cho, Deok Man Hong & Yunseok Jeon

  2. Cheoncheon Public Health Subcenter, Jangsu Health Center and County Hospital, 4 Songtan-ro, Cheoncheon, Jangsu, Jeollabuk-do, 55607, Republic of Korea

    Karam Nam

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  1. Karam Nam
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Correspondence to Yunseok Jeon.

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Conflict of interest

Hippo Medical Company (Seoul, Korea) and Hutchinson (MN, USA) provided the Inspectra™ StO2 tissue oxygenation monitor to Yunseok Jeon. The remaining authors declare that they have no conflict of interest.

Ethical approval

For this type of study formal consent is not required. This analysis was approved by the Institutional Review Board of Seoul National University Hospital, and written informed consent was waived (IRB #1512-046-727).

Informed consent

For this type of study formal consent is not required. Written informed consent was waived under approval of the Institutional Review Board of Seoul National University Hospital (IRB #1512-046-727).

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Nam, K., Oh, HM., Koo, CH. et al. Microvascular reactivity measured by vascular occlusion test is an independent predictor for postoperative bleeding in patients undergoing cardiac surgery. J Clin Monit Comput 32, 295–301 (2018). https://doi.org/10.1007/s10877-017-0020-4

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  • DOI: https://doi.org/10.1007/s10877-017-0020-4

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