Heparin reduction with the use of cardiotomy suction is associated with hyperfibrinolysis during distal aortic perfusion with a heparin-coated semi-closed cardiopulmonary bypass system |
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Authors: | Norihiko Shiiya MD PhD Kenji Matsuzaki MD Takashi Kunihara MD PhD Hiroshi Sugiki MD |
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Institution: | (1) Department of Cardiovascular Surgery, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo 060-8648, Japan |
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Abstract: | We sought to elucidate the effects of different anticoagulation levels and the use of cardiotomy suction on the postoperative
coagulatory and fibrinolytic systems in patients undergoing distal aortic perfusion using a fully heparin-coated (semi-)closed
cardiopulmonary bypass (CPB) system incorporating a soft reservoir bag. Thirty-two patients were divided into two groups:
those who underwent cardiotomy suction (S group, 18 patients) and those who did not (N group, 14 patients). We administered
1–2 mg/kg heparin in the S group, which achieved an activated clotting time (ACT) of 345 ± 71 s. In the N group, we administered
0.7–1 mg/kg heparin, which achieved an ACT of 297 ± 52 s. Data on platelet counts and serum levels of fibrinogen, antithrombin
III, D-dimer, and fibrin degradation products (FDP) were collected, and factors influencing these variables were analyzed
by multiple regression analysis. Both the patient group and the initial ACT level were independent factors influencing postoperative
levels of FDP and D-dimer, whereas peak ACT level and the use of selective visceral/renal shunt/perfusion, but not the patient
group, were independent factors influencing the postoperative platelet counts. In the S group, a significant inverse correlation
was found between the ACT and levels of FDP or D-dimer, whereas no correlation was found in the N group. The use of cardiotomy
suction was associated with elevated FDP and D-dimer levels even when a fully heparin-coated semi-closed CPB system was used.
Lower ACT levels with the use of cardiotomy suction were associated with higher FDP and D-dimer levels, whereas such a relationship
did not exist when cardiotomy suction was not used. |
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Keywords: | Distal aortic perfusion Cardiotomy suction Heparin reduction Heparin-coated semi-closed cardiopulmonary bypass system |
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