Heparin-coated circuits for high-risk patients: a multicenter, prospective, randomized trial.
BACKGROUND
Heparin-coated circuits (HCCs) in low-risk cardiac patients who have coronary revascularization have a limited impact on postoperative outcome. In this prospective, randomized investigation, we studied high-risk patients who had cardiac operations with or without HCCs.


METHODS
A total of 886 patients who had cardiac operations with cardiopulmonary bypass and at least one patient-related or procedure-related risk factor were enrolled in a multicenter study. They were randomly allocated to have cardiopulmonary bypass with Duraflo II HCCs (HCC group, n = 442) or conventional circuits (control group, n = 444). Postoperative outcome was investigated with respect to the occurrence of organ dysfunction.


RESULTS
HCCs are associated with a shorter intensive care unit and postoperative hospital stay and with a lower rate of patients having a severely impaired clinical outcome (stay in intensive care unit for more than 5 days or death) (relative risk 0.66, p = 0.045). Lung dysfunction rate was significantly lower for the patients in HCC group affected by chronic obstructive pulmonary disease or who had mitral procedure (relative risk, respectively, 0.31, p = 0.018 and 0.05, p = 0.02). Renal dysfunction rate was significantly (p = 0.05) lower for diabetics in the HCC group (relative risk 0.28).


CONCLUSIONS
When HCCs were used postoperative times decreased and they had a protective effect on lung and kidney function in high-risk patients.
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D003920:Diabetes Mellitus / Q000503:physiopathology; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008173:Lung Diseases, Obstructive / Q000503:physiopathology; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome