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J Thorac Cardiovasc Surg 2002;124:321-332
© 2002 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Coagulation, fibrinolysis, and cell activation in patients and shed mediastinal blood during coronary artery bypass grafting with a new heparin-coated surface

From the Department of Medical Sciences, Clinical Chemistry, Laboratory for Coagulation Research,^a the Departments of Oncology, Radiology, and Clinical Immunology,^b and the Department of Cardiothoracic Surgery,^c University Hospital, Uppsala, Sweden.

This study was supported by the Foundation for Strategic Research in Sweden and the Medical Research Council.

Received for publication Aug 21, 2001. Revisions requested Oct 16, 2001; revisions received Dec 26, 2001. Accepted for publication Dec 28, 2001. Address for reprints: Agneta Siegbahn, MD, PhD, Laboratory for Coagulation Research, Clinical Chemistry, Department of Medical Sciences, University Hospital, SE-751 85 Uppsala, Sweden (E-mail: Agneta.Siegbahn{at}clm.uas.lul.se).

Objectives: Heparin coating of the cardiopulmonary bypass circuit is shown to improve the biocompatibility of the surface. We have studied a new heparin surface, the Corline Heparin Surface, applied to a complete set of an extracorporeal device used during coronary artery bypass grafting in terms of activation of inflammation, coagulation, and fibrinolysis in patients and in shed mediastinal blood.
Methods: Sixty patients scheduled for coronary artery bypass grafting were randomized to one of 3 groups with heparin-coated devices receiving either a standard, high, or low dose of systemic heparin or to an uncoated but otherwise identical circuit receiving a standard dose of systemic heparin. Samples were drawn before, during, and after the operation from the pericardial cavity and in shed mediastinal blood. No autotransfusion of shed mediastinal blood was performed.
Results: The Corline Heparin Surface significantly reduced the activation of coagulation, fibrinolysis, platelets, and inflammation compared with that seen with the uncoated surface in combination with a standard dose of systemic heparin during cardiac surgery with cardiopulmonary bypass. Both a decrease and an increase of systemic heparin in combination with the coated heparin surface resulted in higher activation of these processes. A significantly higher expression of all studied parameters was found in the shed mediastinal blood compared with in systemic blood at the same time.
Conclusions: The Corline Heparin Surface used in cardiopulmonary bypass proved to be more biocompatible than an uncoated surface when using a standard systemic heparin dose. The low dose of systemic heparin might not be sufficient to maintain the antithrombotic activity, and the high dose resulted in direct cell activation rather than a further anti-inflammatory and anticoagulatory effect.

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