Clinical use of heparin-coated cardiopulmonary bypass in coronary artery bypass grafting

Clinical handling, rislk and benefit of a heparin-coated cardiopulmonary by pass system combined with reduced systemic heparinization in coronary bypas s 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 adm inistered in an initial dose of 400 IE/kg body weight. During ECC activated clotting time (ACT) was kept greater than or equal to 480 sec. Group B (n = 77) had the same ECC set completely coated with low-molecular-weight hepa rin; 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, bu t i.v. heparin was reduced to 150 IE/kg, and was set to be greater than or equal to 240 sec during ECC ACT. The same circulatory components were used in all 3 groups including roller pumps, coronary suction and an open cardio tomy reservoir. In the postoperative clinical course, recovery was not sign ificantly different between groups, especially with respect to organ dysfun ction; but there was significantly reduced postoperative bleeding where hep arin-coated ECC and low-dose systemic heparinization were both used. This c irculatory technique was also associated with a distinctly lower need for p ostoperative blood replacement. We conclude that heparin-coated extracorpor eal circulation combined with either full-dose or reduced systemic heparini zation can be used effectively with the same standard equipment and procedu res as in uncoated technology. Combination with low-dose i.v. heparin leads to significantly decreased blood loss and less need for blood replacement.