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Heparin-coated cardiopulmonary bypass circuit: clinical effects in pediatric cardiac surgery
K Miyaji1, R L Hannan, J Ojito
1Department of Cardiovascular Surgery, Miami Children's Hospital, Florida, USA. kagami111@aol.com
Insights
Heparin-coated cardiopulmonary bypass (CPB) circuits significantly improved urine output during surgery and reduced the need for mechanical ventilation in pediatric cardiac patients. These findings suggest a reduced inflammatory response and systemic edema, leading to routine use of coated circuits.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Pediatric Critical Care
Background:
- Cardiopulmonary bypass (CPB) can trigger inflammatory responses and complement activation.
- Heparin-coated circuits are hypothesized to mitigate these CPB-associated effects.
- Clinical outcomes of heparin-coated circuits in pediatric cardiac surgery require further investigation.
Purpose of the Study:
- To compare the clinical effects of heparin-coated versus noncoated perfusion circuits in pediatric cardiac surgery.
- To evaluate the impact of circuit type on inflammatory response markers and clinical outcomes.
- To determine the safety and efficacy of heparin-coated circuits in young patients undergoing cardiac procedures.
Main Methods:
- Retrospective comparison of 203 pediatric patients (< 10 kg) undergoing cardiac surgery.
- 153 patients utilized heparin-coated bypass circuits (Group H), and 50 used noncoated circuits (Group N).
- Patients in Group N were matched to 100 patients in Group H based on age, weight, and procedure type. Key outcomes included urine output, blood product usage, ventilation duration, hospital stay, morbidity, and mortality.
Main Results:
- Group H demonstrated significantly greater urine output during bypass (11.3 mL/kg/hr vs. 4.8 mL/kg/hr, p < 0.0001).
- Postoperative mechanical ventilation duration was markedly reduced in Group H (2.8 days vs. 5.1 days, p < 0.05).
- No statistically significant differences were observed in red blood cell usage, hospital stay, morbidity, or mortality, though trends suggested decreased transfusion needs in Group H.
Conclusions:
- Heparin-coated circuits in pediatric cardiac surgery are associated with improved intraoperative urine output and reduced postoperative ventilation time.
- These findings suggest that heparin-coated circuits may attenuate the acute inflammatory response, capillary leakage, and systemic edema.
- The study supports the routine use of heparin-coated circuits for pediatric cardiopulmonary bypass cases.
Objectives:
Heparin-coated cardiopulmonary bypass (CPB) circuits have been reported to reduce complement activation and the inflammatory response associated with CPB. We retrospectively compared patients utilizing heparin-coated perfusion circuits with those using noncoated circuits to determine the clinical effects of the different circuits in pediatric cardiac surgery.
Methods:
Between July 1995 and July 1997, 203 patients weighing < 10 kg underwent cardiac surgery, 153 patients using heparin-coated bypass circuits and 50 patients using noncoated circuits. The 50 patients operated on with the noncoated circuit (Group N) were matched to 100 patients operated on with coated circuits (Group H) in age, weight, and type of procedure. Urine output during bypass, blood products used after bypass, postoperative ventilation days, hospital stay, morbidity, and mortality were compared between these groups.
Results:
Body weight, perfusion time, and procedure time were not different between the two groups. Urine output during bypass was notably greater in Group H than in Group N (11.3 +/- 10.5 mL/kg per hour vs 4.8 +/- 3.1 mL/kg per hour, respectively, p < 0.0001). Postoperative mechanical ventilation markedly decreased in Group H (Group H vs N = 2.8 +/- 2.7 days vs 5.1 +/- 7.5 days, respectively, p < 0.05). Red blood cell usage, hospital stay, morbidity, and mortality were not statistically different, although there was a tendency toward decreased transfusion of red cell and platelets in Group H (Group H vs N = 61.2 +/- 121.1 mL/kg vs 102.0 +/- 176.7 mL/kg, respectively, in red cell, p = 0.15; and Group H vs N = 7.9 +/- 13.7 mL/kg vs 13.2 +/- 24.5 mL/kg, respectively, in platelets, p = 0.16).
Conclusions:
Patients operated on with the use of heparin-coated circuits had increased urine output during bypass and required less time postoperatively on the ventilator. These results suggest a reduction in the acute inflammatory response, capillary leakage, and overall systemic edema. We now routinely use coated circuits on all pediatric pump cases.
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