Clinical effects of the heparin coated surface in cardiopulmonary bypass

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Abstract
OBJECTIVE: In a randomised study of 120 patients, undergoing primaryoperation for coronary heart decease, two groups were investigated asregards to the effects of heparin coated cardiopulmonary bypass on brainfunction parameters and general clinical outcome. The study group (n = 56)was perfused using an extra-corporeal circuit treated with covalent bondedheparin; the control group (n = 59) used an identical set-up withoutheparin treatment. Systemic heparin doses were calculated to achieve ACTlevels of 250 and 500 s, respectively. Postoperative course was evaluatedby examining a set of clinically relevant parameters including a detailedregistry of postoperative deviations. Brain function was assessed by thebiochemical marker S-100 and tests of memory performance. RESULTS: Therewere several signs of reduced operative trauma in the study group. Hospitalstay was reduced by nearly 1 day (P < 0.05). Time on postoperativeventilatory support was approximately 4 h shorter (P = 0.009). Chest drainblood loss was decreased both at 8 (P = 0.01) and 24 h (P = 0.007)postoperatively. Body temperature was lower after surgery and especially ondays 2 (P = 0.03) and 3 (P = 0.01). Perioperative creatinine elevation wassignificantly reduced (P = 0.03). Neurological deviations were fewer (P =0.01). Brain function assessment revealed reduced plasma levels of S- 100both at termination of cardiopulmonary bypass (P = 0.008) and 7 h later (P= 0.04). However, no remediation of memory impairment could bedemonstrated. CONCLUSIONS: Cardiopulmonary bypass with covalent bondedheparin attached to the extra-corporeal circuit in combination with areduced systemic heparin dose seems to reduce safely and effectively theoperative stress to the patient. There were also signs of improved cerebralprotection.

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