Advertisement

Routine Use of Heparin-Bonded Circuits with Minimal Anticoagulation for Coronary Artery Bypass Surgery

  • Gabriel S. Aldea
  • Patrick R. Treanor
  • Richard J. Shemin
Chapter

Abstract

Many advances in blood conservation techniques are currently being applied during coronary artery bypass grafting (CABG). These include the use of cell saving to enhance intraoperative blood salvage,1–3 the use of large-bore directional cannulae to minimize shear forces and platelet activation and loss,4 the routine use of antifibrinolytic agents,5–7 normothermic bypass to diminish coagulopathy,8 low-prime cardiopulmonary bypass to diminish dilution of coagulation factors, the use of “tip-to-tip” heparin-bonded cardiopulmonary bypass circuits,9 and postoperative reinfusion of shed blood.10 Despite the proven efficacy of these blood conservation techniques, they have been uniformly applied to all patients undergoing CABG because of their complexity and cost. Consequently, as many as 30% to 70% of patients undergoing CABG still require transfusions.1–3

Keywords

Cardiopulmonary Bypass Fresh Freeze Plasma Fresh Freeze Plasma Transfusion Requirement Extracorporeal Circuit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    LoCicero J III, Massad M, Gandy K, et al. Aggressive blood conservation in coronary artery surgery: impact on patient care.J Cardiovasc Surg (Torino) 1990;31:559–563.Google Scholar
  2. 2.
    Jones JW, Rawitscher RE, McLean TR, et al. Benefits from combining blood conservation measures in cardiac operations.Ann Thorac Surg 1991;51:541–546.PubMedCrossRefGoogle Scholar
  3. 3.
    Scott WJ, Rode R, Castelmain B, et al. Efficacy, complication and cost of a comprehensive blood conservation program for cardiac operations.J Thorac Cardiovasc Surg 1992;103:1001–1007.PubMedGoogle Scholar
  4. 4.
    Pfaender LM. Hemodynamics in extracorporeal aortic cannula: review of factors affecting choice of appropriate size.J Extracorp Tech 1981;13:224–232.Google Scholar
  5. 5.
    Fremes SE, Wong BI, Lee L, et al. Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding.Ann Thorac Surg 1994;58:1580–1588.PubMedCrossRefGoogle Scholar
  6. 6.
    Daily PO, Lamphere JA, Dembitsky WP, et al. Effect of prophylactic epsilon-aminocaproic acid on blood loss and transfusion requirements in patients undergoing first-time coronary artery bypass grafting. A randomized, prospective, double-blinded trial.J Thorac Cardiovasc Surg 1994;108:99–108.PubMedGoogle Scholar
  7. 7.
    Cosgrove DM III, Heric B, Lytle BW, et al. Aprotinin therapy for re-operative myocardial revascularization: a placebo controlled study.Ann Thorac Surg 1992;54:1031–1038.PubMedCrossRefGoogle Scholar
  8. 8.
    Yau TM, Carson S, Weisel RD, et al. The effect of warm heart surgery on post-operative bleeding.J Thorac Cardiovasc Surg 1992;103:1155–1163.PubMedGoogle Scholar
  9. 9.
    von Segesser LK, Weiss BK, Pasic M, et al. Risk and benefits of low systemic heparinization during open heart operations.Ann Thorac Surg 1994;58:391–398.CrossRefGoogle Scholar
  10. 10.
    Morris JJ, Tan YS. Autotransfusion: Is there a benefit in a current practice of aggressive blood conservation?Ann Thorac Surg 1994;58:502–508.PubMedCrossRefGoogle Scholar
  11. Compendium of Scientific Information. Medtronic/Carmeda Bioactive Surface. Medtronic Inc., Minneapolis, MN, 1991.Google Scholar
  12. Compendium II of Clinical and Scientific Information. Carmeda Bioactive Surface. Medtronic Inc., Minneapolis, MN, 1994.Google Scholar
  13. 13.
    Kirklin JK, George JP, Holman W. The inflammatory response to cardiopulmonary bypass. In: Gravlee GP, Davis RF, Utley JR, eds.Cardiopulmonary Bypass, Principles and Practice. Baltimore: Williams & Wilkins, 1993;223–248.Google Scholar
  14. 14.
    Young JA, Kisher CT, Doty DB. Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and appearance of fibrin monomer.Ann Thorac Surg 1978;26:231–240.PubMedCrossRefGoogle Scholar
  15. 15.
    Gravlee GP, Haddon WS, Rothberger HK, et al. Heparin dosing and monitoring during cardiopulmonary bypass.J Thorac Cardiovasc Surg 1990;99:518–527.PubMedGoogle Scholar
  16. 16.
    Cardoso PFG, Yamazaki F, Keshavjee S, et al. A reevaluation of heparin requirement during cardiopulmonary bypass.J Thorac Cardiovasc Surg 1991;101:153–160.PubMedGoogle Scholar
  17. 17.
    Gott VL, Whiffen JD, Datton RC. Heparin bonding on colloidal graphite surfaces.Science 1963;142:1297–1298.PubMedCrossRefGoogle Scholar
  18. von Segesser LK. Experimental and clinical experience with Duraflo II heparin surface coated perfusion equipment.Pathophysiol Tech Cardiopulmonary Bypass Proc 1992;15(abstr).Google Scholar
  19. 19.
    Gu YJ, van Oeveren W, van der Kamp KWHJ, et al. Heparin-coating of extracorporeal circuits reduce thrombin formation in patients undergoing cardiopulmonary bypass.Perfusion 1991;6:221–225.CrossRefGoogle Scholar
  20. 20.
    Borowiec JW, Bylock A, van der Linden J, et al. Heparin reduces blood cell adhesion to arterial filters during coronary bypass: a clinical study.Ann Thorac Surg 1993;55:1540–1545.PubMedCrossRefGoogle Scholar
  21. 21.
    Belboud A, Al-Kaja N, Gudmundsson M, et al. The influence of heparin-coated and uncoated circuits on blood rheology during cardiac surgery.J Extracorp Tech 1993;25(2):40–46.Google Scholar
  22. 22.
    Arnander C, Olsson P. Influence of blood flow and the effect of protamine on thromboresistant properties of covalently bonded heparin surface.Biomed Mater Res 1988;22:859–868.CrossRefGoogle Scholar
  23. 23.
    Redmond JM, Gillinov AV, Stuart RS, et al. Heparin-coated bypass reduce pulmonary injury.Ann Thorac Surg 1993;56(3):474–478.PubMedCrossRefGoogle Scholar
  24. 24.
    Rosengart TK, Helm RE, Klempere J, et al. Combined aprotinin and erythropoietin use for blood conservation: result with Jehovah’s Witnesses.Ann Thorac Surg 1994;58:1397–1403.PubMedCrossRefGoogle Scholar
  25. 25.
    Tabuchi N, Njo TL, Tigchelaar I, et al. Monitoring of anticoagulation in aprotinin treated patients during heart operations.Ann Thorac Surg 1994;58:774–777.PubMedCrossRefGoogle Scholar
  26. 26.
    Taylor KM. Perioperative approaches to coagulation defects.Ann Thorac Surg 1993;56:S78–82.PubMedCrossRefGoogle Scholar
  27. 27.
    Edmunds LH Jr. Surface-bound heparin—panacea or peril?Ann Thorac Surg 1994;58:285–286.PubMedCrossRefGoogle Scholar
  28. 28.
    von Segesser LK, Garcia E, Turina MI. Low-dose heparin versus full-dose aprotinin during cardiopulmonary bypass. A preliminary report.Texas Heart Inst J 1993;20(1):28–32.Google Scholar

Copyright information

© Springer-Verlag New York, Inc. 1998

Authors and Affiliations

  • Gabriel S. Aldea
  • Patrick R. Treanor
  • Richard J. Shemin

There are no affiliations available

Personalised recommendations