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Heparin-coated circuits reduce myocardial injury in heart or heart-lung transplantation: a prospective, randomized
S Wan1, J L LeClerc, M Antoine
1Department of Cardiac Surgery, University Hospital Erasme, Free University of Brussels, Belgium. swan@cuhk.edu.hk
Insights
Heparin-coated circuits may reduce inflammation and myocardial injury during long cardiopulmonary bypass (CPB) times in heart and lung transplants. Further research is needed to confirm these benefits in complex transplant surgeries.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Biomaterials Science
Background:
- Heparin-coated (HC) circuits are used in cardiopulmonary bypass (CPB), but their benefits in lengthy procedures like heart transplantation (HTx) and heart-lung transplantation (HLTx) remain unclear.
- Previous studies focused on shorter CPB durations, leaving potential advantages in extended ischemia times unproven.
Purpose of the Study:
- To evaluate the efficacy of heparin-coated circuits in reducing inflammatory responses and myocardial injury during HTx and HLTx.
- To compare outcomes between patients receiving HC circuits versus standard uncoated circuits in prolonged CPB scenarios.
Main Methods:
- A randomized trial involving 29 patients undergoing HTx or HLTx, assigned to either HC or non-heparin-coated (NHC) circuits.
- Measurement of plasma endotoxin, interleukins (IL-6, IL-8, IL-10, IL-12), and cardiac troponin-I at various time points.
- Blinded assessment of laboratory and clinical staff to the circuit type used.
Main Results:
- No significant differences in CPB duration, ischemic time, blood loss, or ICU stay between HC and NHC groups.
- HC group required more protamine sulfate post-CPB.
- Significantly lower levels of IL-6, IL-8, and IL-10 were observed 1 hour after aortic declamping in the HC group.
- Reduced cardiac troponin-I release was noted 12 and 24 hours post-reperfusion in the HC group.
Conclusions:
- Heparin-coated circuits appear to modulate both pro- and anti-inflammatory responses during prolonged CPB.
- HC circuits may offer a protective effect against myocardial injury in patients undergoing extended CPB and ischemic periods during transplantation.
Background:
The effects of heparin-coated (HC) circuits have been primarily investigated in routine cardiac operations with limited duration of cardiopulmonary bypass (CPB) and ischemia. Their benefits have not been conclusively proven but could be more significant when CPB and ischemic times are longer, such as during heart transplantation (HTx) or heart-lung transplantation (HLTx).
Methods:
In a 22-month period, 29 patients undergoing HTx and HLTx were randomly divided into two groups using HC (Duraflo II, n = 14, 10 HTx and 4 HLTx) or uncoated but identical circuits (NHC group, n = 15, 10 HTx and 5 HLTx). All patients received full systemic heparinization (3 mg/kg) during CPB. Plasma endotoxin, interleukin (IL)-6, IL-8, IL-10, IL-12, and cardiac troponin-I were measured before heparin administration, immediately after aortic cross-clamping, 5, 30, 60, 90, 120 minutes, and 12 and 24 hours after aortic declamping. The intensive care unit (ICU) staff and the laboratory technologists were blinded as to the use of HC circuits.
Results:
No statistically significant differences between groups were found with respect to all baseline values, duration of CPB and aortic cross-clamping, graft ischemic time, doses of heparin, postoperative blood loss and transfusion, peak lactate and creatine kinase-MB isoenzyme values, duration of mechanical ventilation, or length of ICU stay. One patient in each group died during the hospital stay. Patients in the HC group needed more protamine sulfate after CPB. Although endotoxin levels were similar in the two groups, significantly lower IL-6, IL-8, and IL-10 levels were observed 1 hour after aortic declamping in the HC group. The release of cardiac troponin-I was also significantly reduced in the HC group 12 and 24 hours after reperfusion.
Conclusions:
The use of HC circuit limits both pro- and anti-inflammatory responses to CPB. It may also reduce myocardial injury after prolonged duration of CPB and ischemia.