Abstract：
OBJECTIVE: This work was designed to evaluate maximum platelet contractile force and thrombus area before and after cardiopulmonary bypass (CPB) in pediatric patients having congenital heart disease (CHD) surgery using a microfluidic device.
METHODS: A prospective cohort study was designed.
METHODS: The work took place at an academic medical center.
METHODS: Twenty pediatric CHD patients ≤8 years of age with expected CPB time >30 minutes were enrolled.
METHODS: None.
RESULTS: Blood was collected at baseline and post-CPB. Maximum platelet contractile force and thrombus area were evaluated in vitro using a microfluidic device (ATLAS PST). Post-CPB samples were supplemented with recombinant von Willebrand factor (rVWF) to explore the impact on contractile force and thrombus area. At baseline, the maximum thrombus area was 0.06 (0.05, 0.07), and the maximum force was 123.3 nN (68.4, 299.5). Linear mixed-effects regression models showed that the maximum thrombus area was larger post-CPB and post-CPB + rVWF compared with pre-CPB (estimated coefficient [Est] = 0.04, p = 0.002; Est = 0.09, p < 0.001, respectively). The maximum thrombus area was also larger post-CPB + rVWF compared with post-CPB (Est = 0.04, p = 0.001). Force was higher post-CPB + rVWF compared with pre-CPB (Est = 173.32, p = 0.044).
CONCLUSIONS: In pediatric CHD patients, microfluidic testing demonstrated that platelet thrombus area increased slightly after CPB, while platelet contractile force did not change. In vitro addition of rVWF further increased thrombus area, suggesting augmentation of primary hemostasis. Microfluidic assessment of platelet contractile force and thrombus area in pediatric CHD patients appears feasible and can demonstrate changes after CPB. Further studies are needed to determine its accuracy, clinical utility, and normal values for pediatric patients.
METHODS: A prospective cohort study was designed.
METHODS: The work took place at an academic medical center.
METHODS: Twenty pediatric CHD patients ≤8 years of age with expected CPB time >30 minutes were enrolled.
METHODS: None.
RESULTS: Blood was collected at baseline and post-CPB. Maximum platelet contractile force and thrombus area were evaluated in vitro using a microfluidic device (ATLAS PST). Post-CPB samples were supplemented with recombinant von Willebrand factor (rVWF) to explore the impact on contractile force and thrombus area. At baseline, the maximum thrombus area was 0.06 (0.05, 0.07), and the maximum force was 123.3 nN (68.4, 299.5). Linear mixed-effects regression models showed that the maximum thrombus area was larger post-CPB and post-CPB + rVWF compared with pre-CPB (estimated coefficient [Est] = 0.04, p = 0.002; Est = 0.09, p < 0.001, respectively). The maximum thrombus area was also larger post-CPB + rVWF compared with post-CPB (Est = 0.04, p = 0.001). Force was higher post-CPB + rVWF compared with pre-CPB (Est = 173.32, p = 0.044).
CONCLUSIONS: In pediatric CHD patients, microfluidic testing demonstrated that platelet thrombus area increased slightly after CPB, while platelet contractile force did not change. In vitro addition of rVWF further increased thrombus area, suggesting augmentation of primary hemostasis. Microfluidic assessment of platelet contractile force and thrombus area in pediatric CHD patients appears feasible and can demonstrate changes after CPB. Further studies are needed to determine its accuracy, clinical utility, and normal values for pediatric patients.
摘要：
目的：这项工作旨在使用微流体装置评估患有先天性心脏病（CHD）手术的儿科患者在体外循环（CPB）前后的最大血小板收缩力和血栓面积。
方法：设计了一项前瞻性队列研究。
方法：这项工作是在一个学术医学中心进行的。
方法：纳入20例年龄≤8岁、预期CPB时间>30分钟的儿童CHD患者。
方法：无。
结果：在基线和CPB后采集血液。使用微流体装置(ATLASPST)在体外评估最大血小板收缩力和血栓面积。CPB后样品补充重组血管性血友病因子(rVWF)以探索对收缩力和血栓面积的影响。在基线,最大血栓面积为0.06(0.05,0.07),最大力为123.3nN(68.4,299.5)。线性混合效应回归模型显示，与CPB前相比，CPB后和CPB后rVWF的最大血栓面积更大（估计系数[Est]=0.04，p=0.002；Est=0.09，p<0.001）。与CPB后相比，CPB后rVWF的最大血栓面积也更大（Est=0.04，p=0.001）。CPB+rVWF后的力高于CPB前(Est=173.32,p=0.044)。
结论：在儿科冠心病患者中，微流体测试表明，CPB后血小板血栓面积略有增加，而血小板收缩力没有变化。体外添加rVWF进一步增加了血栓面积，提示原发性止血的增加。小儿科冠心病患者的血小板收缩力和血栓面积的微流体评估似乎是可行的，并且可以证明CPB后的变化。需要进一步的研究来确定它的准确性，临床效用，和儿科患者的正常值。
方法：设计了一项前瞻性队列研究。
方法：这项工作是在一个学术医学中心进行的。
方法：纳入20例年龄≤8岁、预期CPB时间>30分钟的儿童CHD患者。
方法：无。
结果：在基线和CPB后采集血液。使用微流体装置(ATLASPST)在体外评估最大血小板收缩力和血栓面积。CPB后样品补充重组血管性血友病因子(rVWF)以探索对收缩力和血栓面积的影响。在基线,最大血栓面积为0.06(0.05,0.07),最大力为123.3nN(68.4,299.5)。线性混合效应回归模型显示，与CPB前相比，CPB后和CPB后rVWF的最大血栓面积更大（估计系数[Est]=0.04，p=0.002；Est=0.09，p<0.001）。与CPB后相比，CPB后rVWF的最大血栓面积也更大（Est=0.04，p=0.001）。CPB+rVWF后的力高于CPB前(Est=173.32,p=0.044)。
结论：在儿科冠心病患者中，微流体测试表明，CPB后血小板血栓面积略有增加，而血小板收缩力没有变化。体外添加rVWF进一步增加了血栓面积，提示原发性止血的增加。小儿科冠心病患者的血小板收缩力和血栓面积的微流体评估似乎是可行的，并且可以证明CPB后的变化。需要进一步的研究来确定它的准确性，临床效用，和儿科患者的正常值。
