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The Journal of Thoracic and Cardiovascular Surgery, Vol 83, 108-116, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JJ van den Dungen, GF Karliczek, U Brenken, JN Homan van der Heide and CR Wildevuur
This clinical study was designed to show differences in hemostasis after
perfusion with membrane (MO) or bubble (BO) oxygenators in cardiopulmonary
bypass. These differences, however, may be obscured by other damaging
factors, such as cardiotomy suction, various perfusion durations, or
different types of operations. Therefore, only patients undergoing coronary
artery bypass grafting were studied. During such operations, rather equal
perfusion durations can be expected and mainly apex vent suction is used.
Data on postoperative blood loss and transfusions were collected from two
groups: one comprising 49 patients perfused with the Travenol TMO membrane
oxygenator (MO group) and the other composed of 25 patients with the
Polystan VT 5000 bubble oxygenator (BO group). In 10 patients of each
group, blood samples were taken at frequent intervals for blood cell
counts, for the determination of platelet function, hematocrit, hemoglobin,
and plasma hemoglobin, for several coagulation tests, and for the
assessment of kidney and liver function. Significant differences between
the two groups were found for postoperative blood loss and transfusions,
both higher in the BO group. Platelet function was better maintained in the
MO group until the moment of releasing the aortic cross-clamp, after which
it decreased concurrently with a doubling of the amount of suction. After
protamine administration, an additional drop of platelet function occurred
and there was virtually no platelet function left in either groups;
however, it recovered 90 minutes after bypass, mainly in the MO group. This
study shows that hemostasis is better preserved with MO perfusion. Still
further improvements may be achieved by preventing the damage of suction
and by a correct protamine dose.
ARTICLES
Clinical study of blood trauma during perfusion with membrane and bubble oxygenators
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