A mathematical analysis of haemorheologic factors during cardiopulmonary bypass for congenital heart disease

Abstract

Rheologic properties of blood are impaired by cardiac surgery using cardiopulmonary bypass. This study was set out to establish a mathematical model in order to assess seven known haemorheologic factors and evaluate their degrees of influence on blood rheology in cardiopulmonary bypass.

Sixteen patients undergoing elective congenital cardiac surgery were studied. High shear blood viscosity, low shear blood viscosity, haematocrit, red blood cell filtration rate, red blood cell electrophoresis time, plasma viscosity and fibrinogen were monitored. The method for mathematical calculation was the stepwise regression analysis.

The results showed that both high shear and low shear blood viscosity were mainly influenced by haematocrit and plasma viscosity. Red blood cell filterability contributed more than red blood cell electrophoresis time for low shear blood viscosity. The mathematical model was re-tested statistically and demonstrated that the selected factors in the model represented approximately 75% of rheologic changes during the surgery. Therefore, this mathematical analysis can be used to estimate the role of various possible haemorheologic factors and evaluate cardiopulmonary bypass techniques and therapeutic interventions.

Get full access to this article

View all access options for this article.

References

Belboul A. , Al-khaja N. , Bergman P. , Roberts D. , William-Olsson G. Red cell deformability changes as a prognostic indicator of postoperative morbidity in cardiac surgery using cardiopulmonary bypass. Vasc Surg 1991; 25 : 476-87.

Hirayama T. , Roberts D. , Allers M. , Belboul A. , Al-Khaja N. , William-Olsson G. Association between pulmonary dysfunction and reduced red cell deformability following cardiopulmonary bypass. Scand J Thor Cardiovasc Surg 1988; 22: 175-77.

Hirayama T. , Roberts D. , Allers M. , Belboul A. , Al-Khaja N. , William-Olsson G. Association between arrhythmias and reduced red cell deformability following cardiopulmonary bypass. Scand J Thor Cardiovasc Surg 1988; 22: 179-80.

Mokken FC , Kedaria M. , Henny CP , Hardeman MR , Gelb AW The clinical importance of erythrocyte deformability, a hemorheological parameter . Ann Hematol 1992; 64: 113-22.

Rosove MH , Perloff JK , Hocking WG , Child JS , Canobbio MM , Skorton DJ Chronic hypoxaemia and decompensated erythocytosis in cyanotic congenital heart disease. Lancet 1986; ii: 313-15.

Baum VC , Perloff JK Anesthetic implications of adults with congenital heart disease. Anesth Analg 1993;76 :1342-58.

Reid HL , Barness AJ , Lock PJ et al. A simple method for measuring erythrocyte deformability. J Clin Pathol 1976; 29 : 355-59.

Hirayama T. , Yamaguchi H. , Allers M. , Roberts D. , William-Olsson G. Changes in red cell deformability associated with anaesthesia and cardiopulmonary bypass in open-heart surgery. Scand J Thor Cardiovasc Surg 1985 ; 19: 257-62.

Brown BA Hematology: principles and procedures, second edition. Philadelphia, PA: Lea and Febiger 1979.

10.

Tzvetanova EM , Gotzev RK Improved biuret method for determination of fibrinogen. Clin Chem 1988; 34: 430-31.

11.

Haycock KA, Roth J, Gagnon J, Finzer WF, Soper C eds. StatView. The ultimate integrated data analysis and presentation system , first edition. Berkeley, CA : Abacus Concepts Inc, 1992.

12.

Bailey Ntj. Statistical methods in biology, seventh edition. London: The English University Press Ltd, 1973:43-51.

13.

Draper NR , Smith H. Applied regression analysis, second edition. New York: John Wiley & Sons, Inc, 1981.

14.

Bourke GJ, Daly LE, McGilvray J eds. Interpretation and uses of medical statistics, third edition. Oxford: Blackwell Scientific Publications, 1985.

15.

Hill AB , Hill ID Bradford Hill's principle of medical statistics, 12th edition. London: Edward Arnold , 1991.

16.

Belboul A. , Al-Khaja N. , Gudmundsson M. et al . The influence of heparin-coated and uncoated extracorporeal circuits on blood rheology during cardiac surgery. J Extracorp Tech. 1993; 25: 40-46.

17.

Bergman P. , Belboul A. , Friberg LG , Al-Khaja N. , Mellgren G. , Roberts D. The effect of prolonged perfusion with a membrane oxygenator (PPMO) on white blood cells. Perfusion 1994 ; 9: 35-40.

18.

Al-Khaja N. , Belboul A. , Bergman P. , Roberts D. , William-Olsson G. Cutaneous microcirculation and blood rheology following cardiopulmonary bypass. Scand J Thorac Cardiovasc Surg 1988; 22: 149-53.

19.

Al-Khaja N. , Bergman P. , Belboul A. , Roberts D. , William-Olsson G. Influence of pathological blood cell microrheology on myocardial microcirculation using cardiopulmonary bypass. Vasc Surg 1990; 24: 73-80.

20.

Kee DB , Wood JH Rheology of the cerebral circulation. Neurosurgery 1984; 15: 125-31.

21.

Larsson H. , Persson SU , Hedner P. Changes in the functional state of the erythrocyte membranes: significance for red cell filterability and blood viscosity. Scand J Clin Lab Invest 1990; 50 : 177-81.

22.

Belboul A. , Al-Khaja N. , Ericson C. et al . The effect of hyperoxia during cardiopulmonary bypass on blood cell rheology and postoperative morbidity associated with cardiac surgery. J Extracorp Technol 1991; 23: 43-48.

23.

Bergman P. , Friberg G. , Liu B. et al. Red blood cell damage during experimental prolonged perfusion with membrane oxygenation using fresh human blood. Perfusion 1993; 8: 225-32.

24.

Territo MC , Rosove MH Cyanotic congenital heart disease: hematologic management. J Am Coll Cardiol 1991;18 :320-22.

25.

Berman W. Jr , Berman N. , Pathak D. , Wood SC Effects of pentoxifylline on blood flow, viscosity, and oxygen transport in young adults with inoperable cyanotic congenital heart disease. Pediatr Cardiol 1994; 15: 66-70.