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Extracorporeal circulation with low systemic heparinization during lung transplantation.
F Pugliese1, F Ruberto, V Ferrazza
1Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Italia. mavif@tiscali.it
Transplantation Proceedings
|June 8, 2006
Summary
This study shows that using preheparinized extracorporeal circulation (ECC) circuits during lung transplantation (LT) is safe and effective. This approach reduces the need for systemic heparinization, avoiding complications in patients with pulmonary hypertension.
Area of Science:
- Cardiothoracic Surgery
- Transplantation Medicine
- Cardiopulmonary Bypass
Background:
- Lung transplantation (LT) recipients often develop pulmonary hypertension and right ventricular dysfunction, necessitating extracorporeal circulation (ECC).
- Standard ECC requires systemic heparinization, which carries significant risks and side effects.
- Alternative strategies to minimize heparinization during ECC in LT are crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of using preheparinized ECC circuits and oxygenators during LT.
- To assess the feasibility of reduced systemic heparinization in patients undergoing LT with ECC.
Main Methods:
- Eight patients undergoing bilateral sequential lung transplantation (BSLT) between 2002 and 2005 were included.
- All patients received ECC via femoro-femoral veno-arterial bypass utilizing preheparinized circuits and an oxygenator.
- Systemic heparinization levels were intentionally kept lower than standard protocols.
Main Results:
- No intraoperative mortality was observed in the study cohort.
- The mean ECC duration was 147.8 minutes, with an average of 3525 UI of heparin administered.
- No perioperative coagulopathy or thrombotic complications were reported.
Conclusions:
- Preheparinized ECC circuits and oxygenators are effective and safe for femoro-femoral bypass during LT.
- This method allows for reduced systemic heparinization in LT patients with severe pulmonary hypertension requiring ECC.
- The findings support the use of preheparinized circuits to mitigate risks associated with systemic anticoagulation in this patient population.