Heparin-coated vs. Non-coated Cardiopulmonary Bypass Circuits: Comparing Immediate Results with Different Target Activated Clotting Time.

Muhammet Onur Hanedan,Mehmet Ali Yürük,Aşkın Kılıç,İlker Mataracı,Ufuk Sayar,Ali Kemal Arslan

doi:10.21470/1678-9741-2019-0387

Abstract

ObjectiveTo compare immediate postoperative results in patients receiving heparin-albumin-coated and non-coated circuits.MethodsA total of 241 patients undergoing on-pump cardiac surgery were divided into two groups: those receiving heparin-coated circuits (Bioline®, Maquet Cardiopulmonary AG., Hirrlingen, Germany) and those receiving non-coated circuits (Maquet Cardiopulmonary AG., Hirrlingen, Germany).ResultsActivated clotting times (ACT) during cardiopulmonary bypass (CPB) were significantly shorter in the heparin-albumin-coated group than in the non-coated group (355.64±34.12 vs. 560.38±90.20, respectively, P=0.001). In-hospital mortality and postoperative stroke rates and lengths of intensive care unit stay were similar between the groups; in contrast, in the heparin-albumin-coated group, patients had significantly better outcomes for hospital stay, drainage, and need for erythrocyte transfusion.ConclusionHeparin-coated circuits and reduced level of systemic heparinization with 300 seconds of target ACT level in cardiac surgery under CPB are safe and result in a very satisfactory clinical course.

Highlights

Activation of the complement cascade, oxidative stress, and coagulation pathways induced by cardiopulmonary bypass (CPB) resulting in systemic inflammatory response syndrome after open heart surgery may cause several complications, like bleeding or organ dysfunctions[1]
In-hospital mortality and postoperative stroke rates and lengths of intensive care unit stay were similar between the groups; in contrast, in the heparinalbumin-coated group, patients had significantly better outcomes for hospital stay, drainage, and need for erythrocyte transfusion
activated clotting time (ACT) during CPB is significantly shorter in the heparin-albumin-coated group than in the non-coated group (355.64±34.12 vs. 560.38±90.20, respectively, P=0.001) In-hospital mortality rates, postoperative cerebrovascular event rates, and lengths of intensive care unit (ICU) stay were similar between the groups; in contrast, patients in the heparin-albumin-coated group had significantly better outcomes for hospital stay, drainage, and need for erythrocyte transfusion

Summary

Introduction

Activation of the complement cascade, oxidative stress, and coagulation pathways induced by cardiopulmonary bypass (CPB) resulting in systemic inflammatory response syndrome after open heart surgery may cause several complications, like bleeding or organ dysfunctions[1]. Several CPB circuits with heparin-coated or surface-modifying agents are available. These systems have been shown to reduce inflammatory response and to provide better hemocompatibility. Heparin is the most known anticoagulant used in CPB because of its rapid onset, effectiveness, ease of reversal by protamine, and low cost. While heparin is most known for its impact on the coagulation pathway, there is some evidence that heparin affects fibrinolysis and platelet function independent of CPB. The effect on fibrinolysis and platelets may result in postoperative bleeding or increasing the transfusions[3]

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