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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 790-798, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LK von Segesser, BM Weiss, E Garcia, A von Felten and MI Turina
After extensive experimental evaluation, heparin-coated perfusion equipment
was clinically evaluated with low or no systemic heparinization in three
different groups of patients (n = 47). In group 1, resection of descending
thoracic aortic aneurysms (n = 24) was performed with heparin-coated
equipment used for left heart bypass (n = 12) or partial cardiopulmonary
bypass (n = 12) for proximal unloading and distal protection (heparin 5000
IU, autotransfusion). All devices remained functional throughout the
procedures and no systemic emboli were detected. The sole death (1 of 24,
4%) occurred in a patient with ruptured thoracoabdominal aortic aneurysm
requiring operation in extremis. Paraparesis with spontaneous recovery
occurred in one patient (1 of 24, 4%). In group 2, coronary artery
revascularization randomized for low (activated clotting time greater than
180 seconds) versus full (activated clotting time greater than 480 seconds)
systemic heparinization was prospectively analyzed in 22 patients. All
patients recovered without sequelae, and no myocardial infarction was
diagnosed. Low dose of heparin (8041 +/- 1270 IU versus 52,500 +/- 17,100
IU; p less than 0.0005) resulted in reduced protamine requirements (7875
+/- 1918 IU versus 31,400 +/- 14,000 IU; p less than 0.0005), reduced blood
loss (831 +/- 373 ml versus 2345 +/- 1815 ml; p less than 0.01), reduced
transfusion requirements of homologous blood products (281 +/- 415 ml
versus 2731 +/- 2258 ml; p less than 0.001), and less patients transfused
(5 of 12 versus 10 of 10; p less than 0.05). Lower D-dimer levels in the
group perfused with low systemic heparinization (0.50 +/- 0.43 mg/L versus
1.08 +/- 0.59 mg/L; p less than 0.05) were attributed to the absence of
cardiotomy suction in this group. In group 3, rewarming in accidental
hypothermia by cardiopulmonary bypass was successfully performed without
systemic heparinization in a patient with hypothermic cardiac arrest (23.3
degrees C) and intracranial trauma. We conclude that systemic
heparinization for clinical cardiopulmonary bypass can be reduced and
eliminated in selected patients if perfusion equipment with improved
biocompatibility is used. Bypass-induced morbidity can be reduced.
ARTICLES
Reduction and elimination of systemic heparinization during cardiopulmonary bypass
Clinic of Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
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L. von Segesser, J. Schilling, B. Leskosek, K. Marquardt, and M. Turina Surface treatments for perfusion devices Perfusion, May 1, 1994; 9(3): 197 - 205. [PDF]
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P. W. Boonstra, Y. J. Gu, C. Akkerman, J. Haan, R. Huyzen, and W. van Oeveren Heparin coating of an extracorporeal circuit partly improves hemostasis after cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., January 1, 1994; 107(1): 289 - 292. [Abstract] [Full Text]
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L. K von Segesser Use of heparin-bonded surfaces in cardiopulmonary bypass Perfusion, May 1, 1993; 8(1_suppl): 21 - 27. [Abstract] [PDF]
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