Clinical use of heparin-coated cardiopulmonary bypass in coronary artery bypass grafting.
Clinical handling, risk and benefit of a heparin-coated cardiopulmonary bypass system combined with reduced systemic heparinization in coronary bypass surgery was investigated in a prospective, randomized clinical study. 243 patients (Pts.) were divided into 3 groups: group A (n = 83) had a standard uncoated extracorporeal circulation (ECC) set, and systemic heparin was administered in an initial dose of 400 IE/kg body weight. During ECC activated clotting time (ACT) was kept > or = 480 sec. Group B (n = 77) had the same ECC set completely coated with low-molecular-weight heparin; i.v. heparin was given in the same dose as in group A, ACT was kept at the same level. Group C (n = 83) had the same coated ECC set as group B, but i.v. heparin was reduced to 150 IE/kg, and was set to be > or = 240 sec during ECC ACT. The same circulatory components were used in all 3 groups including roller pumps, coronary suction and an open cardiotomy reservoir. In the postoperative clinical course, recovery was not significantly different between groups, especially with respect to organ dysfunction; but there was significantly reduced postoperative bleeding where heparin-coated ECC and low-dose systemic heparinization were both used. This circulatory technique was also associated with a distinctly lower need for postoperative blood replacement. We conclude that heparin-coated extracorporeal circulation combined with either full-dose or reduced systemic heparinization can be used effectively with the same standard equipment and procedures as in uncoated technology. Combination with low-dose i.v. heparin leads to significantly decreased blood loss and less need for blood replacement.
Mirow
N
N
Department of Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany. nmirow@hdz-nrw.ruhr-uni-bochum.de
Minami
K
K
Kleikamp
G
G
Tenderich
G
G
Puhlmann
T
T
Körfer
R
R
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D006470:Hemorrhage / Q000209:etiology; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010291:Paresis / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011479:Protamines / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000209:etiology; D020521:Stroke / Q000209:etiology
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011479:Protamines