A combined approach for improving cardiopulmonary bypass in coronary artery surgery: a pilot study.
BACKGROUND
This is a pilot study carried out to assess the feasibility and the clinical impact of a combined approach of cardiopulmonary bypass (CPB) with reduced anti-coagulation.


METHODS
We used a retrospective, non-randomized analysis of 45 consecutive patients undergoing coronary artery bypass using standard CPB with full anticoagulation (activated clotting time, ACT, > 450 s) (Group 1; n = 23) or closed, heparin-coated CPB with low anticoagulation (ACT>250 s), precise heparin and protamine titration, controlled suction, and retrograde autologous prime (Group 2; n = 22).


RESULTS
Patients were similar except for a higher incidence of three-vessel disease in Group 2 (77.3% versus 47.8%; p < 0.03). Heparin was reduced by 41% in Group 2 and protamine by 56% (p < 0.0001). Total postoperative blood loss was similar between Groups 1 and 2 (429 +/- 149 versus 435+/-168 ml, respectively). However, the operative hematocrit decrease was lower in Group 2 (-1.6 +/- 7.5% versus -6.9 +/- 4.8%; p = 0.007), although hemodilution was similar, as reflected by the blood protein level. The need for postoperative inotropic support was less frequent in Group 2 (36.4% versus 65.2%; p = 0.05). Within the subgroup of patients weaned from CPB without requiring inotropic support (n = 35), the cardiac index dropped significantly in Group 1 (p = 0.003) 6 h after the start of CPB, whereas it remained stable in Group 2 (p = 0.92). Using multivariate analyses, Group 2 was found to be more protected than Group 1 against myocardial cellular injury (p = 0.046) and need for postoperative inotropic support (p = 0.014).


CONCLUSIONS
The pejorative postoperative outcome in coronary artery surgery was attenuated through a combined approach aimed at improving CPB.
Baufreton
Christophe
C
Service de Chirurgie Cardio-Vasculaire et Thoracique, CHU d'Angers, Angers Cedex, France. chBaufreton@chu-angers.fr
de Brux
Jean Louis
JL
Binuani
Patrice
P
Corbeau
Jean-Jacques
JJ
Subayi
Jean Baptiste
JB
Daniel
Jean Claude
JC
Treanor
Patrick
P
D000368:Aged; D002302:Cardiac Output; D002315:Cardiopulmonary Bypass / Q000379:methods* / Q000592:standards; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003331:Coronary Vessels / Q000601:surgery*; D003402:Creatine Kinase / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D006400:Hematocrit; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011182:Postoperative Care; D011184:Postoperative Period; D011786:Quality Control; D012189:Retrospective Studies
D002316:Cardiotonic Agents; D003402:Creatine Kinase