Clinical effects of the heparin coated surface in cardiopulmonary bypass.
OBJECTIVE
In a randomised study of 120 patients, undergoing primary operation for coronary heart decease, two groups were investigated as regards to the effects of heparin coated cardiopulmonary bypass on brain function parameters and general clinical outcome. The study group (n = 56) was perfused using an extra-corporeal circuit treated with covalent bonded heparin; the control group (n = 59) used an identical set-up without heparin treatment. Systemic heparin doses were calculated to achieve ACT levels of 250 and 500 s, respectively. Postoperative course was evaluated by examining a set of clinically relevant parameters including a detailed registry of postoperative deviations. Brain function was assessed by the biochemical marker S-100 and tests of memory performance.


RESULTS
There were several signs of reduced operative trauma in the study group. Hospital stay was reduced by nearly 1 day (P < 0.05). Time on postoperative ventilatory support was approximately 4 h shorter (P = 0.009). Chest drain blood loss was decreased both at 8 (P = 0.01) and 24 h (P = 0.007) postoperatively. Body temperature was lower after surgery and especially on days 2 (P = 0.03) and 3 (P = 0.01). Perioperative creatinine elevation was significantly reduced (P = 0.03). Neurological deviations were fewer (P = 0.01). Brain function assessment revealed reduced plasma levels of S-100 both at termination of cardiopulmonary bypass (P = 0.008) and 7 h later (P = 0.04). However, no remediation of memory impairment could be demonstrated.


CONCLUSIONS
Cardiopulmonary bypass with covalent bonded heparin attached to the extra-corporeal circuit in combination with a reduced systemic heparin dose seems to reduce safely and effectively the operative stress to the patient. There were also signs of improved cerebral protection.
Svenmarker
S
S
Department of Cardio-thoracic Surgery, University Hospital of Umeå, Sweden.
Sandström
E
E
Karlsson
T
T
Jansson
E
E
Häggmark
S
S
Lindholm
R
R
Appelblad
M
M
Aberg
T
T
D000925:Anticoagulants / Q000008:administration & dosage; D001927:Brain Diseases / Q000175:diagnosis / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000295:instrumentation*; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D009418:S100 Proteins / Q000097:blood
D000925:Anticoagulants; D009418:S100 Proteins; D006493:Heparin