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Clinical and biomaterial evaluation of hyaluronan-based heparin-bonded extracorporeal circuits with reduced versus full systemic anticoagulation in reoperation for coronary revascularization

Gunaydin, Serdar; Farsak, Bora; Mccusker, Kevin; Vijay, Venkataramana; Sari, Tamer; Onur, M Ali; Gurpinar, Aylin; Zorlutuna, Yaman

Journal of Cardiovascular Medicine: February 2009 - Volume 10 - Issue 2 - p 135–142
doi: 10.2459/JCM.0b013e32831eef9d
Original articles
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Objective This prospective randomized study compares full and reduced heparinization on novel hyaluronan-based heparin-bonded circuits vs. uncoated controls under challenging clinical setting including biomaterial evaluation.

Methods 100 patients undergoing reoperation for coronary artery bypass grafting were allocated into two equal groups (n = 50): Group one was treated with hyaluronan-based heparin bonded preconnected circuits (Vision HFOGBS, Gish, California, USA) and Group two with identical uncoated controls (Vision HFO, Gish, USA). In the study group, half of the patients (n = 25) received low-systemic heparin (125 IU/kg, ACT >250 s) or full dose like control group. Blood samples were collected after induction of anesthesia (T1) and heparin administration before cardiopulmonary bypass (CPB) (T2), 15 min after initiation of CPB (T3), before cessation of CPB (T4), 15 min after reversal with protamine (T5), and the first postoperative day at 08: 00 h (T6).

Results Platelet counts were preserved significantly better at T5, T6 in hyaluronan groups (P < 0.05 vs. control). Serum IL-2 levels were significantly lower at T4, T5 in both hyaluronan groups and C3a levels at T4 and T5 only in low-dose group (P < 0.05). Troponin-T levels in coronary sinus blood demonstrated well preserved myocardium in hyaluronan groups. No significant differences in thrombin–antithrombin levels were observed between full and low-dose heparin groups at any time point. Amount of desorbed protein was 1.41 ± 0.01 in full and 1.43 ± 0.01 in low dose vs. 1.78 ± 0.01 mg/dl in control (P < 0.05).

Conclusion Hyaluronan-based heparin-bonded circuits provided better clinical outcome and less inflammatory response compared with uncoated surfaces. Reduced systemic heparinization combined with hyaluronan-based heparin-bonded circuits is feasible and clinically well tolerated.

aUniversity of Kirikkale, Kirikkale, Turkey

bHacettepe University, Ankara, Turkey

cNew York Medical College, USA

dState University of New York, Brooklyn, New York, USA

eBayindir Hospital, Ankara, Turkey

Received 10 June, 2008

Revised 1 October, 2008

Accepted 21 October, 2008

Correspondence to Serdar Gunaydin, MD, Department of Cardiovascular Surgery, University of Kirikkale, Angora Evleri G-8 Bl. No:1, Beysukent, Ankara 06800, Turkey Tel: +90 536 3896521; fax: +90 318 2252819; e-mail: sgunaydin@isnet.net.tr

© 2009 Italian Federation of Cardiology. All rights reserved.