title: Cardiac surgical patients exposed to heparin-bonded circuits develop less postoperative cerebral dysfunction than patients exposed to non-heparin-bonded circuits.
abstract: A prospective randomized trial was used to study the incidence of cerebral dysfunction in patients undergoing cardiopulmonary bypass (CPB) with heparin-bonded vs non-heparin-bonded circuits. Although the etiology of postoperative cerebral dysfunction is controversial, activation of the systemic inflammatory response may play a role. After institutional approval and informed written consent, 39 elective coronary artery bypass (CABG) patients were studied. A battery of neuropsychometric tests (NPMTs) was performed preoperatively, and 5 days and 6 weeks postoperatively. Significant change in NPMT performance was defined as a 25% or greater decrease in postoperative performance, compared to baseline. The number of abnormal tests per patient was calculated. Analysis using the Mann-Whitney rank test was performed for the first follow-up. Patients randomized to heparin-bonded circuits had fewer abnormal NPMTs (>1 abnormal test) on postoperative day 5 (58 vs 70%, n=19 and 20) than patients randomized to non-heparin-bonded circuits. Patients exposed to heparin-bonded circuits had fewer abnormal tests (>1 abnormal test) at 6 weeks (36 vs 63%, n=14 and 16). Results suggested that the attenuation of systemic inflammation by heparin-bonded CPB circuits may lower the incidence of cerebral injury in cardiac surgical patients.
authors.affiliation: Department of Clinical Perfusion, The New York Presbyterian Medical Center, New York, USA. mongero@cpmail-am.cis.columbia.edu
authors.forename: L B
authors.initials: LB
authors.lastname: Mongero
authors.forename: J R
authors.initials: JR
authors.lastname: Beck
authors.forename: H E
authors.initials: HE
authors.lastname: Manspeizer
authors.forename: E J
authors.initials: EJ
authors.lastname: Heyer
authors.forename: K
authors.initials: K
authors.lastname: Lee
authors.forename: T A
authors.initials: TA
authors.lastname: Spanier
authors.forename: C R
authors.initials: CR
authors.lastname: Smith
mesh_terms: D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods / Q000592:standards; D020099:Coated Materials, Biocompatible / Q000009:adverse effects / Q000592:standards*; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control*; D006493:Heparin / Q000494:pharmacology*; D006801:Humans; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D018709:Statistics, Nonparametric
chemical_list: D020099:Coated Materials, Biocompatible; D006493:Heparin