title: Technique for routine use of heparin bonded circuits with a reduced anticoagulation protocol.
abstract: The use of heparin-bonded cardiopulmonary bypass circuits (HBCs) with reduced anticoagulation protocol during cardiac surgery attenuates some of the adverse pathophysiologic responses to cardiopulmonary bypass (CPB). The strategies of how to maximize improvements in clinical outcomes using this technique are still debated. This article describes in detail a comprehensive approach to strategies developed at Boston Medical Center and the West Roxbury Veteran Affairs Medical Center in over 4000 cases in which HBC with a reduced anticoagulation protocol is used routinely. Important elements of this technique include elimination of cardiotomy reservoir during coronary artery bypass graft surgery (CABG), autologous blood priming, normothermic CPB, and precise heparin and protamine titration. Adaptation and variation in this technique to specific clinical situations is also highlighted.
authors.affiliation: Department of Cardiothoracic Surgery, Boston Medical Center and West Roxbury Veteran Affairs Medical Center, Boston University School of Medicine, Harvard Medical School, Boston, Massachusetts, USA. Paul.Ogara@bmc.org
authors.forename: P J
authors.initials: PJ
authors.lastname: O'Gara
authors.forename: P R
authors.initials: PR
authors.lastname: Treanor
authors.forename: K J
authors.initials: KJ
authors.lastname: Lilly
authors.forename: R F
authors.initials: RF
authors.lastname: Crowley
authors.forename: D L
authors.initials: DL
authors.lastname: Reardon
authors.forename: S F
authors.initials: SF
authors.lastname: Khuri
authors.forename: R J
authors.initials: RJ
authors.lastname: Shemin
authors.forename: G S
authors.initials: GS
authors.lastname: Aldea
mesh_terms: D000925:Anticoagulants; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D002985:Clinical Protocols; D004867:Equipment Design; D006493:Heparin; D006801:Humans; D014481:United States
chemical_list: D000925:Anticoagulants; D006493:Heparin