Cardiac surgical patients exposed to heparin-bonded circuits develop less postoperative cerebral dysfunction than patients exposed to non-heparin-bonded circuits.
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.
Mongero
L B
LB
Department of Clinical Perfusion, The New York Presbyterian Medical Center, New York, USA. mongero@cpmail-am.cis.columbia.edu
Beck
J R
JR
Manspeizer
H E
HE
Heyer
E J
EJ
Lee
K
K
Spanier
T A
TA
Smith
C R
CR
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
D020099:Coated Materials, Biocompatible; D006493:Heparin