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Protective effect of heparin-coated circuits on the platelets during cardiopulmonary bypass
Kailun Zhang1, Zhiwei Hu, Yunhai Yang
1Department of Cardiovascular Surgery, Xiehe Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022.
Insights
Heparin-coated circuits (HCC) significantly reduce platelet loss and activation during cardiopulmonary bypass (CPB). This improves hemocompatibility and reduces postoperative blood loss in patients undergoing heart valve replacement.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Hematology
Background:
- Cardiopulmonary bypass (CPB) can lead to platelet activation and loss, potentially increasing bleeding risks.
- Heparin-coated circuits (HCC) are designed to improve blood compatibility during CPB.
- Understanding the impact of HCC on platelet function is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the protective effect of heparin-coated circuits (HCC) on platelet function during cardiopulmonary bypass (CPB).
- To compare platelet loss, activation markers, and postoperative blood loss between HCC and conventional circuits.
Main Methods:
- A comparative study involving 23 patients undergoing heart valve replacement.
- Patients were divided into a control group (conventional circuits) and an HCC group.
- Platelet count, GMP-140 levels, and postoperative blood loss were measured; arterial filters were examined via electron microscopy.
Main Results:
- The HCC group showed a significant reduction in platelet loss during and after CPB compared to the control group (P<0.05).
- Postoperative blood loss in the first 12 hours was significantly lower in the HCC group (218+/-61 ml) versus the control group (332+/-118 ml) (P<0.05).
- Electron microscopy revealed cleaner filter meshes with fewer adherent cells in the HCC group.
Conclusions:
- Heparin-coated circuits demonstrate a protective effect on platelet function during CPB.
- HCC may reduce platelet activation and improve the hemocompatibility of cardiopulmonary bypass equipment.
- These findings suggest HCC can lead to reduced postoperative bleeding.
Abstract:
To observe the protective effect of heparin-coated circuits (HCC) on the platelet function during cardiopulmonary bypass (CPB), 23 patients with heart valve replacement were studied. The system heparin dose was 3 mg/kg in the control group (n = 15) and heparin-coated circuits in the HCC group (n = 8). Platelet count, alpha-granule membrane protein-140 (GMP-140) concentrations were determined before CPB, at 60 min of CPB, 30 and 60 min after protamine administration, first 12 h after CPB, respectively. At end of CPB the arterial filters in the circuits were observed by electron microscopy. The amount of first 12-h postoperative blood loss was measured. There was significant reduction in platelet loss during and after CPB in the HCC group in contrast to the control group during CPB (P<0.05). During the first 12 h, postoperative blood loss was reduced in the HCC group as compared with that in the control group (218+/-61 ml, vs. 332+/-118 ml, P<0.05). Electron microscopy showed that in the HCC group the filter meshes and their fringes were clear and fragments of floccules were occasionally seen, without adherent cells or only few adherent cells on their surfaces, whereas several cellular and fibrous components were found to adhere to the surfaces of the filter meshes in the control group. This study indicates that heparin-coated circuits might reduce the platelet loss and activation during CPB and improve hemocompatibility of cardiopulmonary bypass equipment.
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