The influence of a heparin-coated oxygenator during cardiopulmonary bypass on postoperative lung oxygenation capacity in pediatric patients with congenital heart anomalies.
BACKGROUND
Cardiopulmonary bypass (CPB) causes an inflammatory response and remarkably depresses the oxygenation capacity of the lung in pediatric patients with pulmonary hypertension. Although a heparin-coated circuit is more biocompatible than an uncoated circuit, the beneficial effect of a heparin-coated circuit on the postoperative lung function in the pediatric patients remains unknown.


METHODS
Sixty patients younger than 3-years-old undergoing heart operations for ventricular septal defect were divided into three groups: group I = children (n = 11) without pulmonary hypertension who underwent CPB with an uncoated oxygenator; group II = children (n = 32) with pulmonary hypertension who underwent CPB with an uncoated oxygenator; and group III = children (n = 17) with pulmonary hypertension who underwent CPB with a heparin-coated oxygenator. A respiratory index (RI) was used to assess the oxygenation capacity of the lung.


RESULTS
RI in group II was significantly higher than in group I and intubation time in group II was significantly longer than in group I. There was a positive correlation between preoperative pulmonary-systemic blood pressure ratio and RI at 3 hours post-CPB. Three and six hours post-CPB, RI in group III was significantly lower than in group II, but there was no significant difference in RI between both groups at 12 hours post-CPB.


CONCLUSIONS
Pulmonary hypertensive pediatric patients were vulnerable to postperfusion lung injury. Beneficial effects of a heparin-coated oxygenator in a CPB circuit was limited to the early hours post-CPB and the postoperative clinical course was not modified by the heparin-coating of a membrane oxygenator.
Watanabe
H
H
Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, Japan.
Miyamura
H
H
Hayashi
J
J
Ohzeki
H
H
Sugawara
M
M
Takahashi
Y
Y
Eguchi
S
S
D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation; D016022:Case-Control Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006493:Heparin; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D007223:Infant; D008168:Lung / Q000503:physiopathology*; D008297:Male; D010107:Oxygenators, Membrane; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*
D006493:Heparin