title: Physiological coagulation can be maintained in extracorporeal circulation by means of shed blood separation and coating.
abstract: OBJECTIVE
  Conventional extracorporeal circulation results in an activation of coagulation cascades. Coating of extracorporeal circulation tubes as well as avoidance of shed blood recirculation have been shown to reduce these phenomena. We evaluated a new shed blood separation system (AVANT D 970) utilizing a coated cardiopulmonary bypass tube system (PHISIO).
  
  
  METHODS
  Forty patients (62 +/- 10 years) underwent isolated coronary revascularization. Four groups (n = 10/group) were defined: no extracorporeal circulation, conventional uncoated extracorporeal circulation, uncoated extracorporeal circulation with shed blood separation, and coated extracorporeal circulation with shed blood separation. Thrombin-antithrombin complex and free Hb were analyzed and statistically compared.
  
  
  RESULTS
  Conventional extracorporeal circulation exhibited the highest intraoperative activation of coagulation (thrombin-antithrombin complex: extracorporeal circulation, 31.1 +/- 15.8 microg/L; uncoated extracorporeal circulation with shed blood separation, 15.3 +/- 7.8 microg/L; coated extracorporeal circulation with shed blood separation, 8.1 +/- 4.8 microg/L; no extracorporeal circulation, 2.4 +/- 0.6 microg/L; P <.05 extracorporeal circulation vs all others) and red blood cell damage (free Hb: extracorporeal circulation, 16.8 +/- 11.4 micromol/L; uncoated extracorporeal circulation with shed blood separation, 10.3 +/- 3.5 micromol/L; coated extracorporeal circulation with shed blood separation, 6.8 +/- 2.9 micromol/L; no extracorporeal circulation, 3.4 +/- 1.1 micromol/L; P <.05 extracorporeal circulation vs no extracorporeal circulation, coated extracorporeal circulation with shed blood separation). Coated extracorporeal circulation with shed blood separation showed only slight activation and cell trauma, which did not differ significantly from no extracorporeal circulation.
  
  
  CONCLUSIONS
  Combination of coating and avoidance of shed blood recirculation maintained physiological coagulation levels and markedly reduced red blood cell trauma in extracorporeal circulation procedures. These combined modalities may therefore offer an alternative for off-pump procedures in patients with contraindications for conventional extracorporeal circulation.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller-University-Hospital, Jena, Germany. j.albes@immanuel.de
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Albes
authors.forename: Ingeborg M
authors.initials: IM
authors.lastname: Stöhr
authors.forename: Mirko
authors.initials: M
authors.lastname: Kaluza
authors.forename: Annelie
authors.initials: A
authors.lastname: Siegemund
authors.forename: Dirk
authors.initials: D
authors.lastname: Schmidt
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Vollandt
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001780:Blood Coagulation Tests; D001781:Blood Component Removal; D020099:Coated Materials, Biocompatible; D001026:Coronary Artery Bypass / Q000379:methods; D003327:Coronary Disease / Q000175:diagnosis / Q000601:surgery*; D004867:Equipment Design; D004869:Equipment Safety; D005112:Extracorporeal Circulation / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010767:Phosphorylcholine / Q000494:pharmacology*; D010976:Platelet Count; D011184:Postoperative Period; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D010767:Phosphorylcholine