Sally Bannan, Amanda Danby, Dahlia Cowan, Saeed Ashraf, Paul G Martin

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Presentation transcript:

Low Heparinization With Heparin-Bonded Bypass Circuits: Is It a Safe Strategy? Sally Bannan, Amanda Danby, Dahlia Cowan, Saeed Ashraf, Paul G Martin The Annals of Thoracic Surgery Volume 63, Issue 3, Pages 663-668 (March 1997) DOI: 10.1016/S0003-4975(96)01054-5 Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig. 1 Activated coagulation times (ACTs) and heparinase (h) ACTs throughout the course of the experiments. A considerable amount of intersample variability was noted in the ACTs, which was not evident in the heparinase ACTs until the final measurement. At 360 minutes, the ACTs for both circuit types had extended considerably, which indicates consumptive coagulopathy. (HB = heparin-bonded circuit; NB = nonbonded circuit.) The Annals of Thoracic Surgery 1997 63, 663-668DOI: (10.1016/S0003-4975(96)01054-5) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig. 2 Platelet counts fell from baseline levels at 30 minutes in the nonbonded (NB) circuits and at 360 minutes in the heparin-bonded (HB) circuits and were significantly higher in the HB circuits until 360 minutes. (∗∗∗p < 0.005.) The Annals of Thoracic Surgery 1997 63, 663-668DOI: (10.1016/S0003-4975(96)01054-5) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig. 3 White blood cell counts dropped significantly lower than baseline from 30 minutes onward in the nonbonded (NB) circuits but not in the heparin-bonded (HB) circuits and were significantly lower in the NB circuits throughout the course of the experiments. (∗∗p < 0.01; ∗∗∗p < 0.005.) The Annals of Thoracic Surgery 1997 63, 663-668DOI: (10.1016/S0003-4975(96)01054-5) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig. 4 (A) Scanning electron micrograph of heparin-bonded tubing surface after 360 minutes of perfusion. The bumpy appearance is an artifact resulting from exposure of the coated polyvinyl chloride to a vacuum. Scattered fibrin strands have formed. (B) Scanning electron micrograft of nonbonded tubing surface at 360 minutes. It is almost completely obscured by clusters of cells and a dense fibrin network. (Bar = 5 μm). The Annals of Thoracic Surgery 1997 63, 663-668DOI: (10.1016/S0003-4975(96)01054-5) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig. 5 The concentration of soluble P-selectin increased in a time-dependent fashion but was significantly higher in the nonbonded (NB) circuits at all times. (HB = heparin-bonded; ∗∗∗p < 0.01; ∗∗∗p < 0.005.) The Annals of Thoracic Surgery 1997 63, 663-668DOI: (10.1016/S0003-4975(96)01054-5) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig. 6 Plasma leukocyte elastase levels rose after 30 minutes of perfusion in both circuit types but significantly more so in the nonbonded (NB) circuits at 30 and 120 minutes. (HB = heparin- bonded; ∗p < 0.05; ∗∗p < 0.01.) The Annals of Thoracic Surgery 1997 63, 663-668DOI: (10.1016/S0003-4975(96)01054-5) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig. 7 Interleukin-8 (IL-8) levels did not differ until 120 minutes of perfusion. Then significantly more IL-8 was measured in the nonbonded (NB) samples until the end of the experiment. (HB = heparin-bonded; ∗p < 0.05; ∗∗p < 0.005.) The Annals of Thoracic Surgery 1997 63, 663-668DOI: (10.1016/S0003-4975(96)01054-5) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig. 8 Levels of thrombin-antithrombin complex were elevated in the baseline bag sample and reduced on initiation of blood circulation. Then they rose in a time-dependent fashion and were significantly higher in the nonbonded (NB) circuit until 120 minutes. (HB = heparin-bonded; ∗∗∗p < 0.005.) The Annals of Thoracic Surgery 1997 63, 663-668DOI: (10.1016/S0003-4975(96)01054-5) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions