Assisted circulation without systemic heparinization.
The need for improvements in materials and equipment for extracorporeal circulation has been obvious for years. Among the surfaces with biologically active compounds, those with heparin binding have been found sufficiently thromboresistant and particularly suitable for different types of artificial perfusion. Partial left heart bypass (LHBP) was performed in 10 anesthetized, acutely instrumented, and open-chested mongrel dogs (weight 23 to 50 kg) with a servo-controlled roller pump. The pump flow was maintained at 50 mL/kg/min for 6 hours. Heparin surface-coated equipment was used without additional heparin. For LHBP with a standard circuit, the total amount of heparin during the study period was (mean +/- SD) 487 +/- 124 IU/kg. The right atrial, pulmonary artery, and left ventricular end-diastolic pressures, cardiac output, left ventricular output, right and left ventricular stroke work, pulmonary gas exchange, and acid-base balance changed similarly with both systems. Blood loss (204 +/- 78 v 1,240 +/- 586 mL, P < 0.0005), volume substitution requirements (647 +/- 48 v 1,860 +/- 764 mL, P < 0.0025), and oxygen extraction ratio (mean 25.4 to 32.0 v 25.4 to 56.4%, P < 0.025) were significantly lower, and mean aortic pressure (mean 65 to 69 v 62 to 38 mmHg, P < 0.025) and hemoglobin concentration (mean 9.1 to 8.1 v 9.4 to 3.9 g/dL, P < 0.05) were significantly higher during 6 hours of LHBP without systemic heparinization. Low but stable oxygen delivery was provided with heparin-coated LHBP, whereas it showed a descending trend (mean 14.0 to 10.8 v 13.4 to 5.5 mL/kg/min, P < 0.1) with the standard circuit.(ABSTRACT TRUNCATED AT 250 WORDS)
Weiss
B M
BM
Institute of Anesthesiology, University Hospital Zürich, Switzerland.
von Segesser
L K
LK
Turina
M I
MI
Vetter
W
W
Seifert
B
B
Pasch
T
T
D000818:Animals; D016280:Atrial Function, Right / Q000502:physiology; D001672:Biocompatible Materials / Q000737:chemistry*; D016063:Blood Loss, Surgical; D001794:Blood Pressure / Q000502:physiology; D001803:Blood Transfusion; D002302:Cardiac Output / Q000502:physiology; D004285:Dogs; D005112:Extracorporeal Circulation / Q000295:instrumentation*; D006339:Heart Rate / Q000502:physiology; D006353:Heart-Assist Devices; D006454:Hemoglobins / Q000032:analysis; D006493:Heparin / Q000097:blood / Q000737:chemistry* / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D013499:Surface Properties; D016277:Ventricular Function, Left / Q000502:physiology; D016278:Ventricular Function, Right / Q000502:physiology; D017725:Ventricular Pressure / Q000502:physiology; D014914:Whole Blood Coagulation Time
D001672:Biocompatible Materials; D006454:Hemoglobins; D006493:Heparin; D010100:Oxygen