Heparin-coated vs. Non-coated Cardiopulmonary Bypass Circuits: Comparing Immediate Results with Different Target Activated Clotting Time

Abstract

Objective To compare immediate postoperative results in patients receiving heparin-albumin-coated and non-coated circuits. Methods A total of 241 patients undergoing on-pump cardiac surgery were divided into two groups: those receiving heparin-coated circuits (Bioline®, Maquet Cardiopulmonary AG., Hirrlingen, Germany) and those receiving non-coated circuits (Maquet Cardiopulmonary AG., Hirrlingen, Germany). Results Activated clotting times (ACT) during cardiopulmonary bypass (CPB) were significantly shorter in the heparin-albumin-coated group than in the non-coated group (355.64±34.12 vs. 560.38±90.20, respectively, P =0.001). In-hospital mortality and postoperative stroke rates and lengths of intensive care unit stay were similar between the groups; in contrast, in the heparin-albumin-coated group, patients had significantly better outcomes for hospital stay, drainage, and need for erythrocyte transfusion. Conclusion Heparin-coated circuits and reduced level of systemic heparinization with 300 seconds of target ACT level in cardiac surgery under CPB are safe and result in a very satisfactory clinical course.

Commercial and novel anticoagulant ECMO coatings: a review

“…27,28 Hanedan et al showed that shorter activated clotting times could be achieved after CPB using Bioline-coated cannulas and low systemic heparin dosage compared to uncoated cannulas; however, the intensive care unit (ICU) length of stay and in-hospital mortality rate were similar in both cases. 29 The Trillium Biosurface, another type of coating, consists of two layers: an underlayer of hydrophilic polymer that can bind tightly to the surface of most materials and act as a primer; the top layer that is a covalently bonded polymer of heparin that contains sulphate or sulphonate groups and polyethylene oxide chains that act as anticoagulants. 28,30 Palanzo et al showed that the Trillium Biosurface was not significantly different from the Carmeda coating when comparing several metrics, such as the post-CPB platelet count and postoperative receipt of platelet infusions.…”

Designing an Experimental Method for Assessing Biocompatibility of Circuit Coatings Using Biomarkers for Platelet Activation During Cardiopulmonary Bypass

“…Recent advances in bypass technologies have created biocompatible surfaces with the aim of potentially decreasing platelet activation during CPB, therefore, reducing the number of complications after surgery. Heparin-coated circuits are widely used because they seem not to cause excessive platelet activation as compared to non-coated circuits [5]. Another commonly used circuit poly-2-methoxyethyl acrylate (PMEA) has a protective water layer that allows proteins to retain their conformation and reduce adherence to foreign surfaces [6].…”