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J Thorac Cardiovasc Surg 2006;132:675-680
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Failure of surface-modified bypass circuits to improve platelet function during pediatric cardiac surgery

^a Division of Cardiac Surgery, Emory University School of Medicine, Atlanta, Ga
^b Division of Cardiac Anesthesiology, Emory University School of Medicine, Atlanta, Ga
^c Department of Biostatistics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Ga
^d Perfusion Services, Children's Healthcare of Atlanta, Atlanta, Ga.
^e Cardiac Research Department, Children's Healthcare of Atlanta, Atlanta, Ga.

Presented at the Forty-second Annual Meeting of the Society of Thoracic Surgeons, Chicago, Ill, Jan 30–Feb 1, 2006.

Received for publication March 30, 2006; revisions received May 2, 2006; accepted for publication May 8, 2006.

^_* Address for reprints: Paul M. Kirshbom, MD, 1365 Clifton Rd, Suite A2100, Emory Clinic A, Atlanta, GA 30322. (Email: paul.kirshbom{at}emoryhealthcare.org).

OBJECTIVE: Surface-modified cardiopulmonary bypass circuits have been shown to improve platelet function and decrease postoperative bleeding after heart surgery in adults. Two surface-modified cardiopulmonary bypass circuits are approved and commercially available for pediatric cardiac surgery. There have been few studies demonstrating the efficacy of these modifications for children. We performed a prospective, randomized trial comparing surface-modified cardiopulmonary bypass circuits to a standard unmodified circuit in pediatric cardiac surgery.

METHODS: Sixty-nine children (median 6 months old) undergoing first-time cardiac surgery were enrolled and randomized to an uncoated circuit or one of the two commercially available surface modified circuits for their operation. Blood samples were collected at baseline, on cardiopulmonary bypass, at the end of rewarming, after protamine, and at 18 to 24 postoperative hours. Platelet count, ß-thromboglobulin, and thromboelastography with and without abciximab were measured. Postoperative chest tube outputs and blood product utilization were also analyzed.

RESULTS: The platelet counts, ß-thromboglobulin levels, thromboelastographic measures of platelet function, and postoperative bleeding were not significantly different between the surface-modified cardiopulmonary bypass circuit groups and the control group.

CONCLUSION: Currently available surface-modified cardiopulmonary bypass circuits do not significantly improve platelet function or clinical outcomes after routine pediatric cardiac surgery.

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