Use of heparin-bonded circuits in cardiopulmonary bypass improves clinical outcome.
OBJECTIVE
The use of heparin-coated surfaces in cardiopulmonary bypass has been shown to decrease the inflammatory response imposed by the contact between blood and artificial surfaces. One would expect this reaction to improve clinical outcome. However, this has been difficult to verify. This investigation is based on an aggregation of two randomized studies from our institution and highlights possible effects of heparin coating on a number of clinically oriented parameters.


METHODS
Departmental analysis of patients subjected to coronary artery bypass surgery using heparin-coated circuits. Cardiopulmonary bypass was employed using either the Carmeda or Duraflo heparin coatings compared with a control. The systemic heparin dose was reduced in the heparin-coated groups (ACT > 250 s) vs control group patients (ACT > 480 s). The effects of heparin coating related to clinical outcome were studied.


RESULTS
The use of heparin-coated circuits reduced the mean length of stay in hospital from 7.8 +/- 2.5 to 7.3 +/- 1.8 days (p = 0.040) and postoperative ventilation time from 9.7 +/- 9.2 to 8.2 +/- 8.5 h (p = 0.018), blood loss 8 h post surgery from 676 +/- 385 to 540 +/- 245 ml (p = 0.001), individual perioperative change of haemoglobin loss (p = 0.001), leukocyte count (p = 0.000) and creatinine elevation (p = 0.000), proportion of patients exposed to allogenous blood transfusions 39.2 vs 23.9% (p = 0.001), postoperative coagulation disturbances 4.4 vs 0.4% (p = 0.006), postoperative deviations from the normal postoperative course 47.2 vs 36.7% (p = 0.035), neurological deviations 9.4 vs 3.9% (p = 0.021) and atrial fibrillation 26.4 vs 18.0% (p = 0.041). No effects were found with respect to perioperative platelet count, postoperative fever reaction and 5-year survival.


CONCLUSIONS
Based on several indicators, the use of heparin coating in cardiopulmonary bypass is associated with improved clinical results.
Svenmarker
S
S
Department of Surgery and Perioperative Science, Division of Cardiothoracic Surgery, University Hospital, Umeå, Sweden. staffan.svenmarker@vll.se
Häggmark
S
S
Jansson
E
E
Lindholm
R
R
Appelblad
M
M
Sandström
E
E
Aberg
T
T
D000368:Aged; D000704:Analysis of Variance; D001772:Blood Cell Count; D001831:Body Temperature; D002315:Cardiopulmonary Bypass / Q000379:methods*; D020099:Coated Materials, Biocompatible / Q000008:administration & dosage*; D003401:Creatine / Q000097:blood; D005260:Female; D005334:Fever; D006454:Hemoglobins / Q000032:analysis; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage; D018709:Statistics, Nonparametric; D014691:Ventilation
D020099:Coated Materials, Biocompatible; D006454:Hemoglobins; D006493:Heparin; D003401:Creatine