Enhanced blood conservation in primary coronary artery bypass surgery using heparin-bonded circuits with lower anticoagulation

Background: Despite many advances in blood conservation techniques, a significant proportion of patients undergoing primary coronary revascularization still require homologous transfusions. A comprehensive strategy to diminish perioperative blood loss was developed by integrating many individual components to create an improved blood conservation environment and was prospectively applied to 557 patients undergoing primary coronary artery bypass grafting (CABG) procedures performed in our medical center over a 14-month period. Methods: The first 455 patients were treated with conventional, nonheparin-bonded circuits (NHBCs) and full anticoagulation (activated clotting time [ACT] > 480 sec). We wanted to test the hypothesis of whether ''tip-to-tip'' heparin-bonded circuits (HBCs) used in conjunction with lower anticoagulation (ACT > 280 sec) when added to our current blood conservation environment can further enhance clinical outcomes. We prospectively applied this technique to a consecutive group of patients (n = 102). Results: Compared to patients treated with NHBCs, patients treated with HBCs had a significantly lower mediastinal and pleural chest tube output in the first 24 hours (683 +/- 561 mt vs 984 +/- 616 mt, p < 0.00001) were less likely to be transfused (52% vs 68.1%, p < 0.01) and had a lower exposure to different blood donor units (4.1 +/- 8.4 vs 9.3 +/- 10.3, p < 0.000003). There were no complications directly related to HBCs used in conjunction with lower anticoagulation. Morbidity and mortality rates were similar in both treatment groups. Conclusion: In summary, HBCs in conjunction with lower anticoagulation were safely applied in patients undergoing primary CABG with marked improvement in blood conservation, and should be considered for broader clinical use.