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Enhanced blood conservation and improved clinical outcome after valve surgery using heparin-bonded cardiopulmonary
O M Shapira1, G S Aldea, J Zelingher
1Department of Cardiothoracic Surgery, Boston University Medical Center, Massachusetts 02118, USA.
Insights
Heparin-bonded (HBC) cardiopulmonary bypass circuits significantly reduced bleeding and transfusion needs in valve surgery. While improving outcomes, caution is advised regarding anticoagulation levels with HBCs due to potential thrombosis risks.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Device Technology
Background:
- Heparin-bonded cardiopulmonary bypass circuits (HBC) show promise for improved outcomes in coronary artery bypass grafting.
- Limited data exists on the efficacy and safety of HBC in valve surgery.
Purpose of the Study:
- To evaluate the safety and efficacy of HBCs in patients undergoing first-time valve surgery.
- To compare outcomes between patients using HBCs with lower anticoagulation and those using conventional non-heparin-bonded circuits (NHBC) with full heparinization.
Main Methods:
- Retrospective cohort study of 352 patients (120 HBC, 232 NHBC) undergoing first-time valve surgery between 1992-1995.
- Comparison of postoperative outcomes including bleeding, transfusion requirements, mortality, and complications.
Main Results:
- HBC group showed significantly lower 24-hour chest tube drainage (558 vs 1054 mL) and reoperations for bleeding (2.5% vs 8.2%).
- HBC patients required fewer transfusions (6.9 vs 18.6 units).
- Overall complications were reduced in the HBC group (42% vs 56.2%), with similar perioperative mortality and major adverse events like myocardial infarction and stroke.
Conclusions:
- HBCs with lower anticoagulation in valve surgery reduce transfusion needs and improve clinical outcomes.
- Conventional anticoagulation levels are recommended with HBCs in valve surgery until further data on mechanical valve thrombosis is available.
Background:
Recently, heparin-bonded (HBC) cardiopulmonary bypass circuits (CPB) were formed to be associated with improved outcome after coronary artery bypass grafting. There are very few reports on the efficacy and safety of these circuits in valve surgery.
Methods:
A retrospective cohort study of all patient populations undergoing first time valve surgery from 1992 to 1995 in a tertiary teaching hospital. Outcomes of 120 patients undergoing valve surgery using HBC and lower anticoagulation HBC were compared to 232 patients treated with conventional circuits and full heparinization (nonheparin-bonded-circuit [NHBC]).
Results:
Postoperative 24-hour chest tube drainage (558 +/- 466 mL vs 1054 +/- 911 mL, p < 0.00001), and reoperation for bleeding (2.5% vs 8.2%, p = 0.04) were lower in the HBC group. HBC patients required significantly less transfusions (total donor exposure of 6.9 +/- 13.0 units vs 18.6 +/- 26.2 units, p < 0.00001). Multiple linear regression analysis identified CPB time as a predictor of increased homologous blood transfusions, and the use of HBC, a large body surface area, and elective procedure as predictors of decreased transfusions. Perioperative mortality was similar (HBC 2.5%, NHBC 4.7%, p = 0.24). Overall complications were lower in the HBC group (42% vs 56.2%, p = 0.02). Perioperative myocardial infarction (0.8% vs 1.3%, p = 0.58) and cerebrovascular accident (3.3% vs 3.9%, p = 0.53) were similar. Two (1.7%) HBC patients had valve re-replacement compared to none in the NHBC (p = 0.22). Multiple logistic regression model revealed that age and CPB time were associated with increased complications, and the use of HBC with reduced complications.
Conclusion:
Use of HBCs with lower anticoagulation in valve surgery resulted in a significant reduction of transfusion requirements and improved clinical outcome. Because of a potential for early mechanical valve thrombosis, until further data is available, conventional levels of systemic anticoagulation should be achieved when using HBC in valve surgery.