Impact of heparin bonding on pediatric cardiopulmonary bypass: a prospective randomized study.
BACKGROUND
Heparin-coated circuits reduce the inflammatory response to cardiopulmonary bypass in adult patients; however, little is known about its effects in the pediatric population. Two studies were performed to assess this technology's impact on inflammation and clinical outcomes.


METHODS
In a pilot study, complement and interleukins were measured in 19 patients who had either uncoated cardiopulmonary bypass circuits or heparin-bonded circuits. Subsequently, 23 additional patients were studied in a randomized fashion. Respiratory function and blood product utilization were recorded.


RESULTS
In the pilot study, heparin-bonded circuit patients had less complement 3a (p < 0.001) and interleukin-8 (p < 0.05) compared with uncoated cardiopulmonary bypass circuit patients. The randomized study revealed that the heparin-bonded circuit was associated with reduced complement 3a (p = 0.02). Multiple variable analysis revealed that the following postoperative variables were increased with bypass time (p = 0.01) and diminished with heparin-bonded circuits: interleukins (p = 0.01), peak airway pressures (p = 0.05), and prothrombin time (p = 0.03).


CONCLUSIONS
Heparin-bonded circuits significantly reduce cytokines and complement during cardiopulmonary bypass and lower interleukin levels postbypass; they were also associated with improved pulmonary and coagulation function. Heparin-bonded circuits ameliorate the systemic inflammatory response in pediatric patients from cardiopulmonary bypass.
Division of Cardiothoracic Surgery, New York University School of Medicine, New York, USA. grossi@cv.med.nyu.edu
E A
EA
Grossi
K
K
Kallenbach
S
S
Chau
C C
CC
Derivaux
M G
MG
Aguinaga
B M
BM
Steinberg
D
D
Kim
S
S
Iyer
M
M
Tayyarah
M
M
Artman
A C
AC
Galloway
S B
SB
Colvin
D002315:Cardiopulmonary Bypass; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible; D015926:Complement C3a / Q000032:analysis; D015936:Complement C5a / Q000032:analysis; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D013499:Surface Properties
D020099:Coated Materials, Biocompatible; D005343:Fibrinolytic Agents; D007375:Interleukin-1; D015850:Interleukin-6; D016209:Interleukin-8; D015926:Complement C3a; D015936:Complement C5a; D006493:Heparin