ENHANCED BLOOD CONSERVATION IN PRIMARY CORONARY-ARTERY BYPASS-SURGERYUSING HEPARIN-BONDED CIRCUITS WITH LOWER ANTICOAGULATION

Background: Despite many advances in blood conservation techniques, a significant proportion of patients undergoing primary coronary revascu larization still require homologous transfusions. A comprehensive stra tegy to diminish perioperative blood loss was developed by integrating many individual components to create an improved blood conservation e nvironment and was prospectively applied to 557 patients undergoing pr imary coronary artery bypass grafting (CABG) procedures performed in o ur medical center over a 14-month period. Methods: The first 455 patie nts were treated with conventional, nonheparin-bonded circuits (NHBCs) and full anticoagulation (activated clotting time [ACT] > 480 sec). W e wanted to test the hypothesis of whether ''tip-to-tip'' heparin-bond ed circuits (HBCs) used in conjunction with lower anticoagulation (ACT > 280 sec) when added to our current blood conservation environment c an further enhance clinical outcomes. We prospectively applied this te chnique to a consecutive group of patients (n = 102). Results: Compare d to patients treated with NHBCs, patients treated with HBCs had a sig nificantly lower mediastinal and pleural chest tube output in the firs t 24 hours (683 +/- 561 mt vs 984 +/- 616 mt, p < 0.00001) were less l ikely to be transfused (52% vs 68.1%, p < 0.01) and had a lower exposu re to different blood donor units (4.1 +/- 8.4 vs 9.3 +/- 10.3, p < 0. 000003). There were no complications directly related to HBCs used in conjunction with lower anticoagulation. Morbidity and mortality rates were similar in both treatment groups. Conclusion: In summary, HBCs in conjunction with lower anticoagulation were safely applied in patient s undergoing primary CABG with marked improvement in blood conservatio n, and should be considered for broader clinical use.