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Ann Thorac Surg 2003;76:129-135
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

A prospective, double-blind study on the efficacy of the bioline surface-heparinized extracorporeal perfusion circuit

George M. Palatianos, MDa*, Christophoros N. Foroulis, MDa, Maria I. Vassili, MDb, George Astras, MDa, Konstantinos Triantafillou, MDa, Emmanuel Papadakis, MDa, Angela A. Lidoriki, RNa, Eugenia Iliopoulou, BScc, Efthimia N. Melissari, MDc

a Third Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
b Department of Anesthesiology, Onassis Cardiac Surgery Center, Athens, Greece
c Laboratory of Coagulation and Hemostasis, Onassis Cardiac Surgery Center, Athens, Greece

Accepted for publication February 13, 2003.

* Address reprint requests to Dr Palatianos, Onassis Cardiac Surgery Center, 356 Sygrou Ave, 176 74, Athens, Greece
e-mail: palatianos{at}otenet.gr

BACKGROUND: We evaluated the newly introduced Bioline heparin coating and tested the hypothesis that surface heparinization limited to the oxygenator and the arterial filter will ameliorate systemic inflammation and preserve platelets during cardiopulmonary bypass (CPB).

METHODS: In a prospective double-blind study, 159 patients underwent coronary revascularization using closed-system CPB with systemic heparinization, mild hypothermia (33°C), a hollow-fiber oxygenator, and an arterial filter. The patients were randomly divided in three groups. In group A (controls, n = 51), surface heparinization was not used. In group B (n = 52), the extracorporeal circuits were totally surface-heparinized with Bioline coating. In group C (n = 56), surface heparinization was limited to oxygenator and arterial filter.

RESULTS: No significant difference was noted in patient characteristics and operative data between groups. Operative (30-day) mortality was zero. Platelet counts dropped by 12.3% of pre-CPB value among controls at 15 minutes of CPB, but were preserved in groups B and C throughout perfusion (p = 0.0127). Platelet factor 4, plasmin-antiplasmin levels, and tumor necrosis factor-{alpha} increased more in controls during CPB than in groups B or C (p = 0.0443, p = 0.0238 and p = 0.0154 respectively). Beta-thromboglobulin, fibrinopeptide-A, prothrombin fragments 1 + 2, factor XIIa levels, bleeding times, blood loss, and transfusion requirements were similar between groups. Intensive care unit stay was shorter in groups B and C than in controls (p = 0.037).

CONCLUSIONS: Surface heparinization with Bioline coating preserves platelets, ameliorates the inflammatory response and is associated with a reduced fibrinolytic activity during CPB. Surface heparinization limited to the oxygenator and the arterial filter had similar results as totally surface-heparinized circuits.




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