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Impact of a phosphorylcholine-coated cardiac bypass circuit on blood loss and platelet function: a prospective,
Sandrine Marguerite1, François Levy, Astrid Quessard
1Department of Surgical Anesthesia and Intensive Care, Civil Hospital, Strasbourg University Hospital, Strasbourg, France. Sandrine.marguerite@chru-strasbourg.fr
Insights
Phosphorylcholine (PC)-coated cardiopulmonary bypass (CPB) circuits reduced early postoperative bleeding in cardiac surgery patients. However, PC-coating did not significantly improve platelet function due to high patient variability.
Area of Science:
- Biomedical Engineering
- Cardiovascular Surgery
- Hematology
Background:
- Cardiopulmonary bypass (CPB) surgery can lead to platelet dysfunction and increased bleeding risk.
- Optimizing CPB circuits is crucial for mitigating surgical complications.
Purpose of the Study:
- To evaluate the impact of a phosphorylcholine (PC)-coated CPB circuit on blood loss, transfusion requirements, and platelet function.
- To compare PC-coated CPB with standard uncoated CPB in adult cardiac surgery patients.
Main Methods:
- Prospective, randomized study involving 40 adult patients undergoing coronary artery bypass graft (CABG) or mitral valve repair.
- Patients were assigned to either PC-coated or uncoated CPB circuits.
- Blood loss, transfusion needs, platelet activation, and thrombin generation were assessed intraoperatively and postoperatively.
Main Results:
- Significantly lower blood loss was observed in the PC-coated CPB group within the first 6 postoperative hours (p = .024).
- No significant differences were found in platelet activation, thrombin generation, or transfusion needs between groups.
- Platelet count decreased by 48% in both groups during CPB.
Conclusions:
- PC-coating of CPB circuits effectively reduces early postoperative bleeding, particularly in CABG patients.
- PC-coating did not demonstrate a significant effect on platelet function, likely due to substantial interindividual variations.
- Further research may be needed to explore strategies to overcome variability in platelet response.
Abstract:
Platelet dysfunction due to cardiopulmonary bypass (CPB) surgery increases the risk of bleeding. This study analyzed the effect of a phosphorylcholine (PC)-coated CPB circuit on blood loss, transfusion needs, and platelet function. We performed a prospective, randomized study at Strasbourg University Hospital, which included 40 adults undergoing coronary artery bypass graft surgery (CABG) (n = 20) or mitral valve repair (n = 20) using CPB. Patients were randomized either to PC-coated CPB or uncoated CPB (10 CABG patients and 10 mitral valve repair patients in each group). Blood loss and transfusion needs were evaluated intra- and postoperatively. Markers of platelet activation and thrombin generation were measured at anesthesia induction, at the beginning and end of CPB, on skin closure, and on days 0, 1, and 5. Comparisons were made by Student's t test or covariance analysis (significance threshold p < or = .05). Blood loss was significantly lower in the PC group during the first 6 postoperative hours (171 +/- 102 vs. 285 +/- 193 mL, p = .024), at the threshold of significance from 6-24 hours (p = .052), and similar in both groups after 24 hours. During CPB, platelet count decreased by 48% in both groups. There was no difference in markers of platelet activation, thrombin generation, or transfusion needs between the two groups. Norepinephrine use was more frequent in the control group (63% vs. 33%) but not significantly. PC-coating of the CPB surface reduced early postoperative bleeding, especially in CABG patients, but had no significant effect on platelet function because of large interindividual variations that prevented the establishment of a causal relationship.
