HEPARIN-COATED CARDIOPULMONARY BYPASS CIRCUITS IN CORONARY-BYPASS SURGERY

Cardiopulmonary bypass (CPB) is a nonphysiologic environment for an or ganism. The damage of blood components may also lead to organ dysfunct ion, sometimes recognized as postperfusion syndrome. One possible way to diminish the risk of these complications would be to reduce the tho rombogenicity and to improve the biocompatibility of the artificial su rfaces by using a heparin-coated CPB circuit. In this study, we compar ed a heparin-coated CPB circuit with a noncoated CPB circuit in terms of biocompatibility in 20 patients undergoing elective coronary bypass surgery. We employed a Duraflo II (n=10) as a heparin-coated CPB circ uit and a Univox IC (n=10) as control subjects. Ten patients (Group C) were operated on using the heparin-coated CPB circuit. A total of 10 patients were given heparin in a reduced dose (2.0 mg/kg), and additio nal heparin was given if the activated clotting time (ACT) was below 4 00 s. The control group also included 10 patients (Group NC), who were operated on with noncoated devices. They received 2.5 mg/kg of hepari n, and additional heparin was given if the ACT was below 450 s. All pa tients had normal coagulation parameters and did not receive blood tra nsfusion. We measured complement activation levels (C3a, C4a), platele t count, thrombin-antithrombin III complex levels, D-dimer levels, and ACT during CPB and respiratory index postoperatively. The concentrati on of C3a in group NC was significantly higher than that in group C. P latelet reduction in group NC was significantly greater than that in g roup C. There were no significant differences in the remaining paramet ers between the 2 groups. We concluded that heparin-coated CPB circuit s improved biocompatibility by reducing complement activation and plat elet consumption and enabled us to reduce the dose of heparin required for systemic heparinization.