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Clinical outcome after coronary surgery with heparin-coated extracorporeal circuits for cardiopulmonary bypass
C Baufreton1, P Le Besnerais, P Jansen
1Department of Thoracic and Cardiovascular Surgery, CNRS URA 1431, Hopital Henri Mondor, Créteil.
Insights
Heparin-coated extracorporeal circuits (ECC) significantly reduced adverse events in 200 patients undergoing coronary artery surgery. This innovative approach lowered complications and arrhythmias compared to standard ECC.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Medicine
Background:
- Extracorporeal circuits (ECC) are essential in cardiac surgery but can trigger inflammatory responses.
- Heparin coating of ECC is hypothesized to mitigate complement activation and improve patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of heparin-coated ECC in reducing postoperative complications in patients undergoing coronary artery surgery.
- To compare clinical outcomes between patients using heparin-coated ECC and those using uncoated ECC.
Main Methods:
- A prospective randomized trial involving 200 patients undergoing coronary artery surgery.
- Patients were allocated to either heparin-coated ECC or uncoated ECC groups, with baseline characteristics matched.
- Outcomes assessed included postoperative bleeding, transfusion rates, and overall adverse events within five days post-surgery.
Main Results:
- Heparin-coated ECC did not significantly reduce postoperative bleeding or transfusion requirements.
- However, adverse events, including mortality and morbidity, were significantly lower in the heparin-coated ECC group (8 vs. 20 patients, p = 0.013).
- Supraventricular arrhythmias were also less frequent with heparin-coated ECC (4 vs. 13 patients, p = 0.02).
Conclusions:
- Heparin coating of extracorporeal circuits is a significant predictive factor for reducing adverse events after coronary artery surgery.
- The findings suggest that heparin-coated ECC can improve clinical outcomes by minimizing postoperative complications.
Abstract:
In this prospective randomized trial, we studied whether heparin-coated extracorporeal circuits (ECC), known to reduce complement activation, could improve the clinical outcome of 200 patients undergoing coronary artery surgery. Patients have been divided into two groups (heparin-coated ECC and uncoated ECC groups) which were similar in terms of age, gender, left ventricle function, preoperative aspirin use and consequent intraoperative aprotinin use, number of grafts, duration of aortic cross-clamping and cardiopulmonary bypass. Univariate analysis showed that heparin coating did not reduce significantly postoperative bleeding (640 +/- 311 versus 682 +/- 342 ml with uncoated ECC) nor the need for transfusion (19% of patients versus 25% with uncoated ECC). Adverse events, including all mortality and morbidity noticed during the five first postoperative days, occurred in 20 patients of the uncoated ECC group and in eight patients of the heparin-coated ECC group (p = 0.013). The most frequent complications were supraventricular arrhythmias that occurred in 13 patients of the uncoated ECC group and in four patients of the heparin-coated ECC group (p = 0.02). Multivariate analysis by stepwise logistic regression showed that only heparin coating of the ECC was shown as a significant predictive factor of adverse events reduction (p = 0.01; odds ratio = 0.34). These data suggest that heparin coating reduced postoperative complications in patients undergoing coronary artery surgery.