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Heparin-coated circuit in coronary surgery. A clinical study
A Sáenz1, G Larrañaga, L Alvarez
1Cardiovascular Unit, Policlínica Guipuzcoa, San Sebastian, Spain.
Insights
Heparin-coated circuits in coronary bypass surgery significantly reduced blood loss and transfusion needs. This innovation also led to shorter intubation times and lower rethoracotomy rates, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Anesthesiology
Background:
- Coronary artery bypass graft (CABG) surgery involves cardiopulmonary bypass, which can activate the coagulation cascade.
- Traditional extracorporeal circuits necessitate significant heparinization, increasing bleeding risks and transfusion requirements.
- Heparin-coated circuits aim to mitigate the inflammatory and thrombotic responses associated with cardiopulmonary bypass.
Purpose of the Study:
- To evaluate the efficacy of heparin-coated extracorporeal circuits in reducing blood loss and transfusion requirements during routine CABG surgery.
- To compare postoperative outcomes, including bleeding, rethoracotomy rates, intubation time, and mortality, between coated and uncoated circuits.
Main Methods:
- A randomized study involving 101 patients undergoing isolated CABG surgery.
- Patients were assigned to either a heparin-coated Carmeda circuit (n=50) or an uncoated circuit (n=51).
- Standardized surgical procedures and equipment (Medtronic Maxima oxygenator, Biomedicus Biohead) were used; heparinization protocols were adjusted based on circuit type.
Main Results:
- The coated group showed significantly less chest drainage (989.4 vs 1435 ml, P < 0.02) and required fewer homologous blood transfusions (723 vs 1071 ml, P < 0.03).
- Postoperative endotracheal intubation time was shorter in the coated group (12.1 vs 14.6 h, P < 0.05).
- Rates of bleeding requiring rethoracotomy (1/50 vs 4/51) and hospital mortality (1/50 vs 4/51) were lower in the heparin-coated circuit group.
Conclusions:
- Heparin coating of extracorporeal circuits represents a promising strategy to reduce perioperative bleeding and transfusion needs in CABG surgery.
- The observed reductions in blood loss, transfusion requirements, intubation time, and rethoracotomy rates suggest improved patient safety and outcomes.
- Further investigation is warranted to confirm these preliminary findings and establish heparin-coated circuits as a standard of care.
Abstract:
We performed a randomized study in 101 patients who underwent routine isolated coronary bypass graft surgery. In 50 cases an entire coated Carmeda circuit was used (coated group), and an uncoated circuit in the remaining 51 (uncoated group). A Medtronic Maxima oxygenator and a Biomedicus Biohead were used in all cases. Patients with coated circuits received low systemic heparinization with a heparin loading dose of 200 IU/kg, and 300 IU/kg for the control. Activated coagulation time was maintained at more than 275 s for the coated group versus more than 400 s for the uncoated one. The mean age of patients was 64.1 +/- 9.6 for coated and 63.5 +/- 9.7 for the uncoated group. The number of coronary grafts was 3.1 +/- 0.7 for the coated group and 3.1 +/- 0.1 for the uncoated one. Cross-clamp and bypass times were 53 +/- 14 and 98 +/- 24 min for the coated, versus 57 +/- 15 and 104 +/- 24 for the uncoated, group. Chest drainage was 989.4 +/- 509.5 ml for the coated group versus 1435 +/- 1027 for the uncoated one (P < 0.02). The amount of transfused homologous blood was 723 +/- 597 ml for the coated group versus 1071 +/- 831 ml for the uncoated one (P < 0.03). Postoperative endotracheal intubation time was 12.1 +/- 3.6 h for the coated and 14.6 +/- 4.5 h for the uncoated group (P < 0.05). Bleeding required rethoracotomy in 1/50 of the coated group, and in 4/51 of the uncoated one. Hospital mortality was 1/50 in the coated, and 4/51 in the uncoated, group. In our preliminary experience, heparin coating of an extracorporeal circuit reduces post-operative blood loss and blood transfusions in routine coronary bypass operations.