Safe use of heparin-coated bypass circuits incorporating a pump-oxygenator.
Durable, covalently bonded, heparin-coated cardiopulmonary bypass (CPB) circuits with oxygenators have been developed. Proposed advantages of heparin-coated CPB circuits include improved biocompatibility and thromboresistance. The purpose of this study was to evaluate our experience with heparin-coated CPB circuits in 20 patients. Heparin was given to maintain an activated clotting time equal to or greater than 200 seconds, while flow rates were kept equal to or greater than 2 L/min. Indications for use of this circuit included recent stroke, posttraumatic injuries, recent gastrointestinal bleeding, protamine allergies, combined cardiac and noncardiac procedures, and ventricular assist. Mean heparin dosage was 0.50 +/- 0.18 mg/kg and protamine dosage was 57.14 +/- 39.36 mg. Postoperative blood loss and transfusion requirements were minimal. Postoperative complement levels of C3a and C5a were normal, suggesting excellent biocompatibility. There were no deaths or perioperative complications. Heparin-coated CPB circuits using a pump oxygenator can be used safely with low-dose heparin administration in select patients requiring CPB.
Jones
D R
DR
Department of Surgery, West Virginia University, Morgantown.
Hill
R C
RC
Vasilakis
A
A
Hollingsed
M J
MJ
Graeber
G M
GM
Gustafson
R A
RA
Cruzzavala
J L
JL
Murray
G F
GF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D001783:Blood Flow Velocity; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D015926:Complement C3a / Q000032:analysis; D015936:Complement C5a / Q000032:analysis; D016903:Drug Monitoring; D004389:Durable Medical Equipment; D004867:Equipment Design; D005260:Female; D006493:Heparin / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D011479:Protamines / Q000627:therapeutic use; D014914:Whole Blood Coagulation Time
D001672:Biocompatible Materials; D011479:Protamines; D015926:Complement C3a; D015936:Complement C5a; D006493:Heparin