HEPARIN-BONDED CIRCUITS IMPROVE CLINICAL OUTCOMES IN EMERGENCY CORONARY-ARTERY BYPASS-GRAFTING

Compared to patients undergoing elective or urgent coronary artery byp ass grafting (CABG), those undergoing emergency CABG (EM-CABG) have a higher morbidity and mortality. The use of heparin-bonded circuits (HB C) has been shown to improve clinical outcomes in nonemergent CABG pat ients. It is not known, however, whether the improved hemostasis and a ttenuation of the inflammatory response to cardiopulmonary bypass, con ferred by HBC, can overcome the high incidence of comorbid risk factor s in (EM-CABG) patients and improve their outcomes. A retrospective an alysis of 206 consecutive patients undergoing EM-CABG over 4 years (19 93-1997) at one institution was performed. Eighty-one patients were tr eated with conventional non-heparin-bonded circuits (NHBC) with full a nticoagulation protocol (FAP, activated clotting time [ACT] > 480 sec) ; 125 patients were treated with HBC and a lower anticoagulation proto col (LAP, ACT > 280 seconds). Outcomes and results were collected pros pectively and are presented as mean +/- SD. Preoperative risk profiles were similar in both treatment groups. Postoperatively, compared with the NHBC group, patients treated with HBC/LAP required fewer homologo us donor units (4.1 +/- 10.7 vs 8.2 +/- 13.6 units, p = 0.005), were l ess likely to require inotropic support (18.6% vs 38.3%, p = 0.005), a nd had a lower incidence of perioperative myocardial infarction (Ml, 3 .2% vs 12.3%, p = 0.04) and pulmonary complications (4.0% vs 12.3%, p = 0.04). The use of HBC/LAP resulted in a decreased incidence of posto perative complications (12.8% vs 28.4%, p = 0.01, odds ratio 0.37 with 95% confidence interval [CI] 0.18-0.76). This resulted in a shorter d uration of ventilatory support (30.5 +/- 54.0 vs 72.8 +/- 16.7 hours, p = 0.009), ICU stay (38.2 +/- 36.5 vs 91.5 +/- 68.7 hours, p = 0.009) , hospital stay (8.0 +/- 7.1 vs 11.0 +/- 8.9 days, p = 0.008), and the refore cost. In conclusion, the use of HBC/LAP in EM-CABG resulted in a reduction of homologous transfusion and postoperative complications associated with decreased hospital stays and cost.