Risk and benefit of low systemic heparinization during open heart operations.
Heparin surface-coated perfusion equipment with improved thromboresistance was evaluated in 104 consecutive patients undergoing open heart operation in a prospective, randomized trial with low versus full systemic heparinization. Surgical procedures included coronary artery revascularization in 47 of 54 (87%) for low versus 44 of 50 patients (88%; not significant [NS]) for full, valve repair/replacement in 8 of 54 (15%) for low versus 5 of 50 patients (10%; NS) for full, left ventricular aneurysm repair in 1 of 54 (2%) for low versus 2 of 50 patients (4%; NS) for full, and other in 3 of 54 (6%) for low versus 3 of 50 patients (6%; NS) for full. Cross-clamp time was 39.2 +/- 10.7 minutes for low versus 39.5 +/- 10.5 minutes for full (NS). Cardiopulmonary bypass time was 68.6 +/- 20.1 minutes for low versus 69.3 +/- 16.6 minutes for full (NS). Lowest activated coagulation time during perfusion was 255 +/- 75 seconds for low versus 537 +/- 205 seconds for full (p < 0.0005). In the low group, the target activated coagulation time of more than 180 seconds was not reached during perfusion in 4 of 54 patients (7%), the lowest value being 164 seconds. No oxygenator failure occurred. Hospital mortality was 0 of 54 (0%) for low versus 1 of 50 patients (2%) for full (NS). Bleeding required surgical revision in 0 of 54 (0%) for low versus 4 of 50 patients (8%) for full (p = 0.05). Drainage (24 hours) was 790 +/- 393 mL for low versus 1,039 +/- 732 mL for full (p < 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)
von Segesser
L K
LK
Clinic for Cardiovascular Surgery, University Hospital, Zürich, Switzerland.
Weiss
B M
BM
Pasic
M
M
Garcia
E
E
Turina
M I
MI
D001777:Blood Coagulation / Q000187:drug effects; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000295:instrumentation; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013499:Surface Properties
D006493:Heparin