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The Annals of Thoracic Surgery, Vol 58, 391-397, Copyright © 1994 by The Society of Thoracic Surgeons
LK von Segesser, BM Weiss, M Pasic, E Garcia and MI Turina
Heparin surface-coated perfusion equipment with improved thromboresistance
was evaluated in 104 consecutive patients undergoing open heart operation
in a prospective, randomized trial with low versus full systemic
heparinization. Surgical procedures included coronary artery
revascularization in 47 of 54 (87%) for low versus 44 of 50 patients (88%;
not significant [NS]) for full, valve repair/replacement in 8 of 54 (15%)
for low versus 5 of 50 patients (10%; NS) for full, left ventricular
aneurysm repair in 1 of 54 (2%) for low versus 2 of 50 patients (4%; NS)
for full, and other in 3 of 54 (6%) for low versus 3 of 50 patients (6%;
NS) for full. Cross-clamp time was 39.2 +/- 10.7 minutes for low versus
39.5 +/- 10.5 minutes for full (NS). Cardiopulmonary bypass time was 68.6
+/- 20.1 minutes for low versus 69.3 +/- 16.6 minutes for full (NS). Lowest
activated coagulation time during perfusion was 255 +/- 75 seconds for low
versus 537 +/- 205 seconds for full (p < 0.0005). In the low group, the
target activated coagulation time of more than 180 seconds was not reached
during perfusion in 4 of 54 patients (7%), the lowest value being 164
seconds. No oxygenator failure occurred. Hospital mortality was 0 of 54
(0%) for low versus 1 of 50 patients (2%) for full (NS). Bleeding required
surgical revision in 0 of 54 (0%) for low versus 4 of 50 patients (8%) for
full (p = 0.05). Drainage (24 hours) was 790 +/- 393 mL for low versus
1,039 +/- 732 mL for full (p < 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Risk and benefit of low systemic heparinization during open heart operations
Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
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