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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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

lingua: Inglese

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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