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Ann Thorac Surg 2004;77:962-967
© 2004 The Society of Thoracic Surgeons
a Department of Pediatric Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
b Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
c Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
Accepted for publication September 4, 2003.
* Address reprint requests to Dr Jensen, c/o Intendent Wivi Linder, Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, S-41345 Gothenburg, Sweden;
e-mail: ev.jensen{at}telia.com
BACKGROUND: This study describes the response in hemostasis during open-heart surgery with cardiopulmonary bypass (CPB) in children (
10 kg) and tests the hypothesis that the use of a biocompatible perfusion system, in comparison with a conventional system, causes less hemostatic activation.
METHODS: Prospective, randomized, controlled clinical study. Forty consecutive children 10 kg were included and divided into two groups: group bioc. (n = 19) treated with a fully heparin-coated system, centrifugal pump, and a closed circuit, and group conv. (n = 21) treated with an uncoated system, roller pump, and a hard shell venous reservoir. Concentrations of plasma thrombin-antithrombin (TAT), D-dimer, tissue plasminogen activator antigen (t-PA ag), and the complex consisting of tissue plasminogen activator and its inhibitor plasminogen activator inhibitor-1 (t-PA-PAI-1) were measured.
RESULTS: The biochemical variables measured increased significantly in both groups during the study period. There was less activation of fibrinolysis during cardiopulmonary bypass (t-PA ag: p = 0.009) in patients treated with the biocompatible perfusion system than in patients treated with the conventional system. A trend in favor of the biocompatible system based on the D-dimer and TAT data (p = 0.07 for both measurements) was observed but no significant intergroup differences regarding these variables or t-PA-PAI-1 were found.
CONCLUSIONS: Open-heart surgery with cardiopulmonary bypass in children ( 10 kg) causes transient activation of the coagulation and fibrinolytic systems. This study demonstrates that the use of a biocompatible perfusion system results in a lower extent of activation of fibrinolysis during CPB than the use of a conventional system.
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