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Closed, phosphorylcholine-coated circuit and reduction of systemic heparinization for cardiopulmonary bypass: the
M Ranucci1, A Pazzaglia, G Isgrò
1Department of Cardiothoracic Anesthesia, Istituto Policlinico S. Donato, University of Milan, Italy. cardioanestesia@virgilio.it
Insights
A novel phosphorylcholine-coated circuit safely reduces systemic heparinization during cardiopulmonary bypass, improving outcomes in cardiac surgery. This approach enhances platelet preservation and lowers bleeding compared to heparin-coated circuits.
Area of Science:
- Biomaterials Science
- Cardiovascular Surgery
- Medical Device Technology
Background:
- Cardiopulmonary bypass (CPB) traditionally requires significant heparinization, increasing bleeding risks.
- Heparin-bonded circuits improve outcomes but systemic heparinization is still necessary.
- Novel biocompatible coatings aim to further reduce heparin requirements during CPB.
Purpose of the Study:
- To evaluate a novel phosphorylcholine (PC)-coated extracorporeal circuit for CPB.
- To assess the safety and efficacy of reduced systemic heparinization with PC-coated circuits.
- To compare clinical outcomes with PC-coated circuits versus traditional heparin-coated circuits.
Main Methods:
- Sixty patients undergoing coronary revascularization used a fully PC-coated CPB circuit.
- A low systemic heparinization protocol (150 IU/kg) targeting activated clotting time (ACT) of 320 seconds was employed.
- Suctions were separated during CPB in a closed-circuit system.
Main Results:
- No thrombus formation occurred within the PC-coated circuit.
- In-hospital mortality was zero; one patient (1.6%) had myocardial infarction, and two (3.3%) required surgical revision for bleeding.
- Homologous blood transfusion rate was 11.6% with mean postoperative bleeding of 310 ± 136 ml.
- Compared to heparin-coated circuits, PC-coated circuits showed better platelet preservation and reduced postoperative bleeding.
Conclusions:
- Phosphorylcholine coating demonstrates low thrombogenicity, enabling safe reduction of systemic heparinization during CPB.
- This heparin-free CPB approach offers promising clinical outcomes for coronary revascularization.
- PC-coated circuits represent a viable alternative to heparin-bonded circuits, enhancing patient safety and recovery.
Abstract:
Cardiopulmonary bypass with heparin-bonded circuits reduces systemic heparinization which is associated to a better clinical outcome in cardiac operations. In the present study, a novel biocompatible treatment, based on a phosphorylcholine coating without heparin, has been used to reduce systemic heparinization during cardiopulmonary bypass. Sixty patients underwent coronary revascularization with a fully phosphorylcholine-coated circuit. The circuit was entirely closed; suctions from the field were separated during the cardiopulmonary bypass time. A low systemic heparinization protocol based on half the loading dose of heparin (150 IU/kg) and a target activated clotting time of 320 seconds was applied. No thrombus formation inside the extracorporeal circulation circuit occurred; in-hospital mortality was absent. One patient (1.6%) had a postoperative myocardial infarction and 2 (3.3%) were surgically revised due to bleeding. Homologous blood transfusion rate was 11.6%, postoperative bleeding was 310 +/- 136 ml. If compared to patients treated with heparin-coated circuits and low systemic heparinization, these patients have better platelet count preservation and lower postoperative bleeding. The low thrombogenicity of phosphorylcholine-treated surfaces, despite the absence of surface-immobilized heparin, allows a safe reduction of systemic heparinization in the setting of an ECMO-like intraoperative cardiopulmonary - bypass. This intraoperative ECMO approach offers promising results in terms of clinical outcome after coronary revascularization operations.
