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The Journal of Cardiovascular Surgery 2000 June;41(3):357-62

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Improved blood cellular biocompatibility with heparin coated circuits during cardiopulmonary bypass

Belboul A., Akbar O., Löfgren C., Jungbeck M., Storm C., Roberts A.

From the Department of Thoracic and Cardiovascular Surgery, University of Göteborg, Sahlgrenska University Hospital and Scandinavian Heart Centre Carlanderska Hospital, Göteborg, Sweden


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Back­ground. The clin­ical use of hep­a­ri­nized sur­faces in the extra­cor­po­real cir­cuit was ­studied to ­find out if ­there was any ­blood ­cell rhe­o­logic ben­efit to sup­port its use in rou­tine low ­risk car­diac sur­gery.
­Methods. In a pros­pec­tive ­single ­blind ­study, 39 ­patients ­were oper­ated ­upon ­with the ­heart ­lung ­machine for ­angina pec­toris by cor­o­nary ­bypass ­grafting and ­were ran­dom­ized to a con­trol ­group or a hep­arin ­group. ­Blood ­cell rhe­ology was ana­lysed ­using the St. ­George fil­trom­eter ­where ­damage to the red ­blood ­cells and ­white ­blood ­cells was esti­mated by ­assessing deform­ability reduc­tions, ­transit, ­time ­increases and clog­ging ­rate and clog­ging par­ticle ­changes.
­Results. At the end of car­di­o­pul­mo­nary ­bypass, in the hep­arin ­group, the red ­cell fil­ter­ability (rFR) and the ­white ­cell fil­ter­ability (WFR) ­were 8% ­better ­than in the con­trol ­group (p=0.0079 and p=0.027 respec­tively). The red ­cell ­transit ­time was 19% ­slower in the con­trol ­group (p=0.0351). The red ­cell clog­ging ­rate (RCR) and clog­ging par­ti­cles (RCP) ­were sig­nif­i­cantly ­lower in the hep­arin ­group (p=0.0212 and p=0.0409 respec­tively. The ­white ­cell clog­ging ­rate (WCR) and clog­ging par­ti­cles (WCP) ­showed a sim­ilar pat­tern.
Con­clu­sions. In ­spite of ­these sig­nif­i­cant dif­fer­ences the clin­ical out­come was sim­ilar in the ­groups. ­Thus hep­arin ­coating of the extra­cor­po­real cir­cuit ­reduces ­blood ­cell rhe­o­logic ­damage sig­nif­i­cantly in low ­risk ­patients under­going rou­tine ­bypass sur­gery for ­angina but ­this use did not ­lead to any clin­ical ben­efit post­op­er­a­tively. There­fore the use of ­such cir­cuits for rou­tine low ­risk car­diac sur­gery ­cannot be rec­om­mended.

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