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J Thorac Cardiovasc Surg 2003;126:1504-1512
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Physiological coagulation can be maintained in extracorporeal circulation by means of shed blood separation and coating

^a Department of Cardiothoracic and Vascular Surgery,^a Friedrich-Schiller-University-Hospital, Jena, Germany
^b Department of Internal Medicine,^b Leipzig University, Leipzig, Germany
^c Department of Clinical Chemistry,^c Friedrich-Schiller-University-Hospital, Jena, Germany
^d Department of Medical Statistics, Informatics, and Documentation,^d Friedrich-Schiller-University Hospital, Jena, Germany

Received for publication September 26, 2002; revisions received February 10, 2003; revisions received June 16, 2003; accepted for publication June 18, 2003.

^* Address for reprints: Johannes M. Albes, MD, Department of Cardiovascular Surgery, Heart Center Brandenburg, Ladeburger Str 17, 16321 Bernau-Berlin, Germany
j.albes{at}immanuel.de

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 µg/L; uncoated extracorporeal circulation with shed blood separation, 15.3 ± 7.8 µg/L; coated extracorporeal circulation with shed blood separation, 8.1 ± 4.8 µg/L; no extracorporeal circulation, 2.4 ± 0.6 µg/L; P < .05 extracorporeal circulation vs all others) and red blood cell damage (free Hb: extracorporeal circulation, 16.8 ± 11.4 µmol/L; uncoated extracorporeal circulation with shed blood separation, 10.3 ± 3.5 µmol/L; coated extracorporeal circulation with shed blood separation, 6.8 ± 2.9 µmol/L; no extracorporeal circulation, 3.4 ± 1.1 µmol/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.

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