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Heparin-bonded circuits decrease myocardial ischemic damage: an experimental study
H L Lazar1, X Zhang, T Hamasaki
1Department of Cardiothoracic Surgery, The Boston University Medical Center, Massachusetts 02118, USA.
Insights
Heparin-bonded cardiopulmonary bypass circuits significantly reduce myocardial damage and improve heart function during surgical revascularization. This innovative approach offers better preservation of heart tissue and function post-surgery.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Cardiac Anesthesia
Background:
- Heparin-bonded cardiopulmonary bypass circuits are known to reduce complement activation.
- The impact of these circuits on myocardial function during surgical revascularization remains largely unknown.
Purpose of the Study:
- To investigate the efficacy of heparin-bonded circuits in mitigating myocardial damage.
- To assess the effect of heparin-bonded circuits on myocardial function during acute surgical revascularization.
Main Methods:
- A porcine model with 16 animals undergoing surgical revascularization was utilized.
- Animals were subjected to coronary occlusion, cardioplegic arrest, and reperfusion.
- Eight animals received heparin-bonded circuits, while the control group used non-bonded circuits.
Main Results:
- Heparin-bonded circuits demonstrated superior preservation of myocardial wall motion.
- Reduced tissue acidosis and a smaller increase in lung water content were observed with heparin-bonded circuits.
- A significantly lower area of necrosis relative to the area at risk was found in the heparin-bonded group.
Conclusions:
- Heparin-bonded circuits significantly decrease myocardial ischemic damage during acute surgical revascularization.
- These findings suggest a protective role for heparin-bonded circuits in preserving cardiac function during bypass procedures.
Background:
Heparin-bonded cardiopulmonary bypass circuits reduce complement activation, but their effect on myocardial function is unknown. This study was undertaken to determine whether heparin-bonded circuits reduce myocardial damage during acute surgical revascularization.
Methods:
In 16 pigs, the second and third diagonal vessels were occluded with snares for 90 minutes followed by 45 minutes of cardioplegic arrest and 180 minutes of reperfusion with the snares released. During the period of coronary occlusion, all animals were placed on percutaneous bypass followed by standard cardiopulmonary bypass during the periods of cardioplegic arrest and reperfusion. In 8 pigs, heparin-bonded circuits were used, whereas 8 other pigs received nonbonded circuits.
Results:
Animals treated with heparin-bonded circuits had the best preservation of wall motion scores (3.5 +/- 0.3 versus 2.3 +/- 0.2; 4 = normal to -1 = dyskinesis; p < 0.05), least tissue acidosis (change in pH = -0.31 +/- 0.02 versus -0.64 +/- 0.08; p < 0.05), smallest increase in lung H2O (1.7% +/- 0.7% versus 6.1% +/- .5%; p < 0.05), and the lowest area of necrosis/area of risk (20.3% +/- 2.2% versus 40.4% +/- 1.6%; p < 0.05).
Conclusions:
We conclude that heparin-bonded circuits significantly decrease myocardial ischemic damage during acute surgical revascularization.