Closed, phosphorylcholine-coated circuit and reduction of systemic heparinization for cardiopulmonary bypass: the intraoperative ECMO concept.
Cardiopulmonary bypass with heparin-bonded circuits reduces systemic heparinization which is associated to a better clinical outcome in cardiac operations. In the present study, a novel biocompatible treatment, based on a phosphorylcholine coating without heparin, has been used to reduce systemic heparinization during cardiopulmonary bypass. Sixty patients underwent coronary revascularization with a fully phosphorylcholine-coated circuit. The circuit was entirely closed; suctions from the field were separated during the cardiopulmonary bypass time. A low systemic heparinization protocol based on half the loading dose of heparin (150 IU/kg) and a target activated clotting time of 320 seconds was applied. No thrombus formation inside the extracorporeal circulation circuit occurred; in-hospital mortality was absent. One patient (1.6%) had a postoperative myocardial infarction and 2 (3.3%) were surgically revised due to bleeding. Homologous blood transfusion rate was 11.6%, postoperative bleeding was 310 +/- 136 ml. If compared to patients treated with heparin-coated circuits and low systemic heparinization, these patients have better platelet count preservation and lower postoperative bleeding. The low thrombogenicity of phosphorylcholine-treated surfaces, despite the absence of surface-immobilized heparin, allows a safe reduction of systemic heparinization in the setting of an ECMO-like intraoperative cardiopulmonary - bypass. This intraoperative ECMO approach offers promising results in terms of clinical outcome after coronary revascularization operations.
Ranucci
M
M
Department of Cardiothoracic Anesthesia, Istituto Policlinico S. Donato, University of Milan, Italy. cardioanestesia@virgilio.it
Pazzaglia
A
A
Isgrò
G
G
Cazzaniga
A
A
Ditta
A
A
Boncilli
A
A
Cotza
M
M
Carboni
G
G
Brozzi
S
S
Bonifazi
C
C
D000925:Anticoagulants / Q000008:administration & dosage*; D002315:Cardiopulmonary Bypass / Q000295:instrumentation* / Q000379:methods; D016022:Case-Control Studies; D002985:Clinical Protocols; D020099:Coated Materials, Biocompatible; D004305:Dose-Response Relationship, Drug; D005240:Feasibility Studies; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010767:Phosphorylcholine; D013997:Time Factors; D014914:Whole Blood Coagulation Time
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D010767:Phosphorylcholine; D006493:Heparin