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Ann Thorac Surg 1996;62:417
© 1996 The Society of Thoracic Surgeons

Discussion

Discussion

The first 20% of the full text of this article appears below.

See also page 140.

DR L. HENRY EDMUNDS (Philadelphia, PA): This is a comprehensive, well-designed, well-executed study that squarely addresses two issues: First, what is the amount of thrombin that we can safely circulate during open heart operations? And second, does surface-bound heparin reduce the morbidity from cardiopulmonary bypass? To my mind, Aldea and associates have answered the second question persuasively, but I think the jury is still out regarding the first.

The first point is that the Duraflo II heparin-coated surface leaks heparin. In Boonstra's work with coated circuits, for the same systemic dose, the amount of heparin in plasma is clearly higher at the end of bypass.

Øvrum's work shows that when the amount of systemic heparin is reduced and a heparin-coated circuit is used, the amount of circulating thrombin is increased. There was a significant increase in F1.2 in the patients who received half-dose systemic heparin and Duraflo-coated circuits at the end of bypass as compared with patients who received a full dose of heparin and an uncoated circuit.

Finally, from our own work, when the same dose of systemic heparin was used with coated or uncoated circuits, there was no difference in the amount of F1.2 that circulated.

This study and many studies from Europe show that it is clinically safe to reduce the amount of circulating heparin and therefore increase the amount of circulating thrombin. However, at what concentration of thrombin do gross clots appear? Is this concentration the same for all patients?

The second question seems to . . . [Full Text of this Article]


Related Article

Heparin-Bonded Circuits With a Reduced Anticoagulation Protocol in Primary CABG: A Prospective, Randomized Study
Gabriel S. Aldea, Mheir Doursounian, Paul O'Gara, Patrick Treanor, Oz M. Shapira, Harold L. Lazar, and Richard J. Shemin
Ann. Thorac. Surg. 1996 62: 410-418. [Abstract] [Full Text]





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Copyright © 1996 by The Society of Thoracic Surgeons.