title: Heparin-bonded cardiopulmonary bypass circuits reduce bleeding and transfusion requirements in proximal aortic surgery.
abstract: BACKGROUND
  Methods to improve hemostasis in aortic surgery continue to evolve. Use of heparin-bonded cardiopulmonary bypass circuits (HBC) has been shown previously to effectively reduce bleeding and improve outcomes in coronary and valve operations.
  
  
  OBJECTIVE
  To evaluate the impact of HBC on bleeding and transfusion requirements in proximal aortic surgery.
  
  
  METHODS
  Data on 140 consecutive patients undergoing 144 operations of the proximal aorta were collected. Between July 1987 and July 1994, conventional cardiopulmonary bypass circuits (CONV) were used (n = 53). In July 1994, we switched to "tip-to-tip" HBC (n = 91). This study compared clinical outcomes and transfusion requirements between these two groups.
  
  
  RESULTS
  Indications for surgery, baseline characteristics, and operative profile of the study groups were similar. Overall operative mortality and reoperation for bleeding were 9% and 13%, respectively. Compared with CONV, use of HBC was associated with decreased mortality (3% vs 18%, p = 0.004), reoperation for bleeding (7% vs 24%, p = 0.005), and hospital length of hospital stay (10 +/- 11 vs 20 +/- 30 days, p = 0.002). Although the incidence of allogeneic blood transfusion was similar (HBC 75% vs CONV 87%, p = 0.12), the magnitude of blood products utilization was much lower in the HBC group (total blood products per patient: 24 +/- 29 vs 49 +/- 47 donor units, p = 0.0002). In the multivariate analyses, use of HBC was identified as an independent predictor of reduced mortality, morbidity, and reduced magnitude of allogeneic blood transfusions.
  
  
  CONCLUSIONS
  Use of HBC in proximal aortic surgery resulted in reduced bleeding and blood transfusion, improving clinical outcomes. Undoubtedly, multiple factors account for the overall improved results. However, use of HBC is an important component of an overall blood conservation strategy.
authors.affiliation: Department of Cardiothoracic Surgery, Boston University School of Medicine, Massachusetts, USA. oshapira@bu.edu
authors.forename: O M
authors.initials: OM
authors.lastname: Shapira
authors.forename: P
authors.initials: P
authors.lastname: O'Gara
authors.forename: S
authors.initials: S
authors.lastname: Roy-Cutter
authors.forename: H L
authors.initials: HL
authors.lastname: Lazar
authors.forename: R J
authors.initials: RJ
authors.lastname: Shemin
mesh_terms: D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D016022:Case-Control Studies; D005260:Female; D006488:Hemostasis, Surgical; D006493:Heparin; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006493:Heparin