Minimal invasive extracorporeal circulation preserves coagulation integrity.

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.