| Physiological coagulation can be maintained in extracorporeal circulation by means of shed blood separation and coating. | |
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MedLine Citation:
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PMID: 14666026 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Conventional extracorporeal circulation results in an activation of coagulation cascades. Coating of extracorporeal circulation tubes as well as avoidance of shed blood recirculation have been shown to reduce these phenomena. We evaluated a new shed blood separation system (AVANT D 970) utilizing a coated cardiopulmonary bypass tube system (PHISIO). METHODS: Forty patients (62 +/- 10 years) underwent isolated coronary revascularization. Four groups (n = 10/group) were defined: no extracorporeal circulation, conventional uncoated extracorporeal circulation, uncoated extracorporeal circulation with shed blood separation, and coated extracorporeal circulation with shed blood separation. Thrombin-antithrombin complex and free Hb were analyzed and statistically compared. RESULTS: Conventional extracorporeal circulation exhibited the highest intraoperative activation of coagulation (thrombin-antithrombin complex: extracorporeal circulation, 31.1 +/- 15.8 microg/L; uncoated extracorporeal circulation with shed blood separation, 15.3 +/- 7.8 microg/L; coated extracorporeal circulation with shed blood separation, 8.1 +/- 4.8 microg/L; no extracorporeal circulation, 2.4 +/- 0.6 microg/L; P <.05 extracorporeal circulation vs all others) and red blood cell damage (free Hb: extracorporeal circulation, 16.8 +/- 11.4 micromol/L; uncoated extracorporeal circulation with shed blood separation, 10.3 +/- 3.5 micromol/L; coated extracorporeal circulation with shed blood separation, 6.8 +/- 2.9 micromol/L; no extracorporeal circulation, 3.4 +/- 1.1 micromol/L; P <.05 extracorporeal circulation vs no extracorporeal circulation, coated extracorporeal circulation with shed blood separation). Coated extracorporeal circulation with shed blood separation showed only slight activation and cell trauma, which did not differ significantly from no extracorporeal circulation. CONCLUSIONS: Combination of coating and avoidance of shed blood recirculation maintained physiological coagulation levels and markedly reduced red blood cell trauma in extracorporeal circulation procedures. These combined modalities may therefore offer an alternative for off-pump procedures in patients with contraindications for conventional extracorporeal circulation. |
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Authors:
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Johannes M Albes; Ingeborg M Stöhr; Mirko Kaluza; Annelie Siegemund; Dirk Schmidt; Rüdiger Vollandt; Thorsten Wahlers |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 126 ISSN: 0022-5223 ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2003 Nov |
Date Detail:
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Created Date: 2003-12-10 Completed Date: 2004-01-14 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1504-12 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller-University-Hospital, Jena, Germany. j.albes@immanuel.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Analysis of Variance Blood Coagulation Tests Blood Component Removal* Coated Materials, Biocompatible* Coronary Artery Bypass / methods Coronary Disease / diagnosis, surgery* Equipment Design Equipment Safety Extracorporeal Circulation / instrumentation*, methods Female Follow-Up Studies Humans Male Middle Aged Phosphorylcholine / pharmacology* Platelet Count Postoperative Period Preoperative Care Prospective Studies Risk Assessment Sensitivity and Specificity Statistics, Nonparametric Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Coated Materials, Biocompatible; 107-73-3/Phosphorylcholine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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