Clinical Use of Heparin-Coated Cardiopulmonary Bypass in Coronary Artery Bypass Grafting[*]

Clinical handling, risk and benefit of a heparin-coated cardiopulmonary bypass system combined with reduced systemic heparinization in coronary bypass surgery was investigated in a prospective, randomized clinical study. 243 patients (Pts.) were divided into 3 groups: group A (n = 83) had a standard uncoated extracorporeal circulation (ECC) set, and systemic heparin was administered in an initial dose of 400 IE/kg body weight. During ECC activated clotting time (ACT) was kept ≥ 480 sec. Group B (n = 77) had the same ECC set completely coated with low-molecular-weight heparin; i. v. heparin was given in the same dose as in group A, ACT was kept at the same level. Group C (n = 83) had the same coated ECC set as group B, but i. v. heparin was reduced to 150 IE/kg, and was set to be ≥ 240 sec during ECC ACT. The same circulatory components were used in all 3 groups including roller pumps, coronary suction and an open cardiotomy reservoir. In the postoperative clinical course, recovery was not significantly different between groups, especially with respect to organ dysfunction; but there was significantly reduced postoperative bleeding where heparin-coated ECC and low-dose systemic heparinization were both used. This circulatory technique was also associated with a distinctly lower need for postoperative blood replacement. We conclude that heparin-coated extracorporeal circulation combined with either full-dose or reduced systemic heparinization can be used effectively with the same standard equipment and procedures as in uncoated technology. Combination with low-dose i. v. heparin leads to significantly decreased blood loss and less need for blood replacement.

Cardiopulmonary bypass - Extracorporeal circulation - Heparin-coating - Low-molecular-weight heparin - Systemic heparinization - Coronary bypass surgery

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1 Presented at the 3^rd Joint Meeting of the German, the Austrian and the Swiss Societies for Thoracic and Cardiovascular Surgery in Lucerne on February 9 - 12, 2000