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Heparin-coated circuits and aprotinin prime for coronary artery bypass grafting
P G Jansen1, C Baufreton, P Le Besnerais
1Service de Chirurgie Thoracique et Cardiovasculaire, Centre Nacional de la Recherche Scientifique Unité de Recherche Associeé 1431, Hôpital Henri Mondor, Créteil, France.
Insights
Heparin-coated circuits significantly reduce patient morbidity and intensive care unit stays after cardiopulmonary bypass surgery. This leads to improved recovery and cost savings, making them a valuable option for cardiac procedures.
Area of Science:
- Biomedical Engineering
- Cardiovascular Surgery
- Medical Device Technology
Background:
- Heparin bonding enhances extracorporeal circuit biocompatibility.
- Cardiopulmonary bypass (CPB) surgery requires extracorporeal circuits.
- Aprotinin prime is used in conjunction with CPB.
Purpose of the Study:
- To evaluate the impact of heparin-coated circuits on postoperative recovery.
- To assess resource utilization in patients undergoing coronary artery bypass grafting (CABG).
- To compare heparin-coated versus uncoated circuits in CPB with aprotinin prime.
Main Methods:
- Prospective study of 102 patients undergoing CABG.
- Random allocation to heparin-coated (n=51) or uncoated (n=51) circuits.
- Analysis of blood loss, transfusion needs, morbidity, and intensive care unit (ICU) stay.
Main Results:
- No significant differences in blood loss or transfusion requirements.
- Heparin-coated group showed a 0.29 relative risk for adverse events.
- Reduced incidence of myocardial infarction, respiratory insufficiency, and neurologic dysfunction in the heparin-coated group.
- Shorter ICU stay (median 2 vs. 3 days) in the heparin-coated group (p=0.03).
- Cost savings from reduced ICU stay offset higher circuit costs.
Conclusions:
- Heparin-coated circuits with aprotinin prime reduce early postoperative morbidity.
- Concomitant decrease in intensive care stay observed.
- Significant cost savings achieved through the use of heparin-coated circuits.
Background:
The biocompatibility of an extracorporeal circuit is improved by heparin bonding onto its inner surface. To determine the effect of heparin-coated circuits for cardiopulmonary bypass with aprotinin prime on postoperative recovery and resource utilization, a prospective study was done in 102 patients undergoing coronary artery bypass grafting with full systemic heparinization.
Methods:
Patients were randomly allocated to be treated with either a heparin-coated circuit (n = 51) or an uncoated circuit (n = 51). Differences in blood loss, need for blood transfusion, morbidity, and intensive care stay were analyzed.
Results:
No differences in blood loss and need for blood transfusion were found between the groups. The relative risk for adverse events in the heparin-coated group was 0.29 (95% confidence interval ranging from 0.10 to 0.80). Adverse events included myocardial infarction (2 patients in the uncoated group versus 0 in the heparin-coated group), rethoracotomy for excessive bleeding (1 versus 2), rhythm disturbance (7 versus 2), respiratory insufficiency (4 versus 0), and neurologic dysfunction (2 versus 0). The lower incidence of adverse events in the heparin-coated group was associated with a shorter intensive care stay (median, 2 days; range, 2 to 5 days) compared with the uncoated group (median, 3 days; range, 2 to 19 days, p = 0.03). The cost savings of 1 day of intensive care stay counterbalanced the additional costs of heparin-coated circuits.
Conclusions:
The use of heparin-coated circuits for cardiopulmonary bypass with aprotinin prime resulted in a significant reduction in mobidity in the early postoperative phase and a concomitant decrease in intensive care stay, resulting in important cost savings.