A randomized study of coronary artery bypass surgery performed with the Resting Heart™ System utilizing a low vs a standard dosage of heparin.
OBJECTIVE
Allogeneic blood transfusion and reoperation for postoperative bleeding after the coronary artery bypass grafting have a negative impact on the patient outcome. This study aimed at evaluating the effects of reduced doses of heparin and protamine on the patient outcome, using a heparin-coated mini-cardiopulmonary bypass (CPB) system.


METHODS
Sixty patients undergoing elective first-time CPB were prospectively randomized either to have a reduced systemic heparinization [activated clotting time (ACT) = 250 s] or to a control group perfused with a full heparin dose (ACT = 420 s). Blood transfusions, ventilation time, early postoperative bleeding, ICU stay, reoperations for bleeding, postoperative cognitive status and the level of mobilization were registered.


RESULTS
Twenty-nine patients were randomized to the control group, 27 patients to the low-dose group and 4 patients were excluded because of protocol violations. Four patients in the control group received a total of 10 units of packed red blood cells, and in the low-dose group, no transfusions were given, P = 0.046. No patient was reoperated because of bleeding. The ICU stay was significantly shorter in the low-dose group (8.4 vs 13.7 h, P = 0.020), less dependent on oxygen on the first postoperative day (78 vs 97%, P = 0.034), better mobilized (89 vs 59%, P = 0.006) and had less pain (visual analogue scale 2.0 vs 3.5, P = 0.019) compared with the control group.


CONCLUSIONS
The use of a mini-CPB system combined with a low dose of heparin reduced the need for blood transfusions and may facilitate the faster mobilization of the patients.
Department of Cardiothoracic Surgery,  Cardiothoracic Anesthesia and Intensive Care, Skåne University Hospital and Lund University, 221 85 Lund,  Sweden.
Johan
J
Nilsson
Sara
S
Scicluna
Gunnar
G
Malmkvist
Leif
L
Pierre
Lars
L
Algotsson
Per
P
Paulsson
Henrik
H
Bjursten
Per
P
Johnsson
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D003071:Cognition; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000295:instrumentation*; D017558:Elective Surgical Procedures; D004867:Equipment Design; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006494:Heparin Antagonists / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010102:Oxygen Inhalation Therapy; D010149:Postoperative Pain / Q000209:etiology / Q000628:therapy; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D011479:Protamines / Q000627:therapeutic use; D012086:Reoperation; D012121:Respiration, Artificial; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D006494:Heparin Antagonists; D011479:Protamines; D006493:Heparin