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Published on: May 26, 2023
Impact of Heparin- or Nonheparin-Coated Circuits on Platelet Function in Pediatric Cardiac Surgery
Chiara Giorni1, Chiara Pezzella1, Mirela Bojan2
1Pediatric Intensive Care, Cardiac Surgery and Perfusion Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Insights
Pediatric cardiopulmonary bypass (CPB) using non-heparin coated circuits showed no significant difference in platelet function or coagulation compared to heparin-coated circuits. Both methods yielded similar biological effects, offering insights for optimizing CPB conduct and cost-effectiveness in congenital heart disease treatment.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Extracorporeal circuit coatings aim to mitigate coagulation issues during pediatric cardiopulmonary bypass (CPB).
- This study evaluated platelet function and hemostasis activation in pediatric cardiac surgery using two distinct circuit coatings: non-heparin (Balance) and heparin-based (Carmeda).
Purpose of the Study:
- To compare the effects of non-heparin coated versus heparin-based coated extracorporeal circuits on platelet function and coagulation activation in pediatric cardiac surgery.
- To determine if differences exist in beta-thromboglobulin levels and other hemostasis indicators between the two circuit types.
Main Methods:
- A prospective, randomized, double-center trial involving pediatric patients (age > 1 month) undergoing congenital heart disease treatment.
- Blood samples were collected at four time points: baseline, during CPB, and at 15 minutes and 1 hour post-CPB.
- Primary endpoint: beta-thromboglobulin levels at 15 minutes post-CPB; Secondary endpoints: other coagulation and platelet function markers.
Main Results:
- Beta-thromboglobulin levels significantly increased post-CPB in both non-heparin and heparin-based coated circuit groups.
- No statistically significant differences in beta-thromboglobulin levels were observed between the two circuit groups at any time point.
- Secondary endpoints related to coagulation and platelet function also showed no significant differences between the groups.
Conclusions:
- Both non-heparin and heparin-based coated extracorporeal circuits demonstrated comparable biological effects on platelet function and coagulation during pediatric CPB.
- These findings suggest that circuit coating type may not significantly impact hemostasis in this patient population.
- The similar performance could aid in optimizing CPB procedures and managing costs for congenital heart disease treatment.
Background:
Extracorporeal circuit coating has been shown to improve coagulation derangements during pediatric cardiopulmonary bypass (CPB). This study compared platelet function and hemostasis activation in pediatric cardiac surgery conducted with nonheparin coating (Balance; Medtronic, Minneapolis, MN) versus heparin-based coating (Carmeda; Medtronic) circuits.
Methods:
A prospective, randomized, double-center trial was conducted in children older than 1 month undergoing congenital heart disease treatment. Blood samples were collected at baseline (T0), 15 minutes after the start of CPB (T1), and 15 minutes (T2) and 1 hour after the conclusion of CPB (T3). The primary end point of the study was to detect potential differences in β-thromboglobulin levels between the two groups at T2. Other coagulation and platelet function indicators were analyzed as secondary end points.
Results:
The concentration of β-thromboglobulin increased significantly at T2 in both groups. However, there was no significant difference between the groups across all time points. There was no difference in the secondary end points between the groups.
Conclusions:
The two circuits showed similar biological effects on platelet function and coagulation. This observation may be useful in optimizing the conduct of CPB and in rationalizing its cost for the treatment of congenital heart disease.
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