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Related Experiment Video

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Is 300 Seconds ACT Safe and Efficient during MiECC Procedures?

Adrian Bauer1,2,3, Harald Hausmann4, Jan Schaarschmidt1

  • 1Department of Cardiovascular Perfusion, MediClin Heart Center Coswig, Coswig, Saxony-Anhalt, Germany.

The Thoracic and Cardiovascular Surgeon
|January 1, 2018
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Summary
This summary is machine-generated.

Modern cardiopulmonary bypass systems allow for reduced anticoagulation. This study found that a lower activated clotting time (ACT) target of 300 seconds is safe, reducing heparin and protamine use without thromboembolic complications.

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Area of Science:

  • Cardiovascular Surgery
  • Anesthesiology
  • Biomedical Engineering

Background:

  • Traditional cardiopulmonary bypass (CPB) relies on high activated clotting time (ACT) levels (≥480 seconds) established with older extracorporeal circulation (ECC) systems.
  • Modern minimal invasive ECC (MiECC) systems feature closed circuits, membrane oxygenators, and surface coatings, suggesting potential for reduced anticoagulation.
  • The current standard ACT for CPB may be unnecessarily high with advanced MiECC technology.

Purpose of the Study:

  • To investigate the safety and efficacy of a reduced anticoagulation strategy using a lower ACT target (300 seconds) in patients undergoing coronary artery bypass grafting with MiECC.
  • To evaluate the potential risks associated with decreased heparin levels during MiECC procedures.
  • To determine if MiECC can be safely operated with ACT levels below the traditional 480-second recommendation.

Main Methods:

  • A randomized study involving 68 patients undergoing coronary artery bypass grafting with MiECC.
  • Patients were assigned to either a study group targeting an ACT of 300 seconds or a control group targeting an ACT of 450 seconds.
  • Heparin and protamine dosages were adjusted based on the assigned ACT target, while other MiECC parameters remained constant.

Main Results:

  • The study group (ACT 300s) received significantly less heparin (32,800 IU vs. 50,000 IU) and protamine (18,000 IU vs. 30,000 IU) compared to the control group (ACT 450s).
  • ACT levels were significantly lower in the study group at the start (400s vs. 633s) and before termination of CPB (344s vs. 506s).
  • No thromboembolic complications were observed in any study participants, and endogenous thrombin potential (ETP) decreased similarly in both groups.

Conclusions:

  • The use of MiECC with a reduced anticoagulation strategy, targeting an ACT of 300 seconds, appears safe and feasible.
  • This approach significantly reduces the required dosages of both heparin and protamine.
  • Larger clinical studies are warranted to establish the definitive clinical safety of ACT levels below 300 seconds.