CLINICAL EFFECTS OF THE HEPARIN-COATED SURFACE IN CARDIOPULMONARY BYPASS

Objective: In a randomised study of 120 patients, undergoing primary o peration for coronary heart decease, two groups were investigated as r egards to the effects of heparin coated cardiopulmonary bypass on brai n function parameters and general clinical outcome. The study group (n = 56) was perfused using an extra-corporeal circuit treated with cova lent bonded heparin; the control group (n = 59) used an identical set- up without heparin treatment. Systemic heparin doses were calculated t o achieve ACT levels of 250 and 500 s, respectively. Postoperative cou rse was evaluated by examining a set of clinically relevant parameters including a detailed registry of postoperative deviations. Brain func tion was assessed by the biochemical marker S-100 and tests of memory performance. Results: There were several signs of reduced operative tr auma in the study group. Hospital stay was reduced by nearly 1 day (P less than or equal to 0.05). Time on postoperative ventilatory support was approximately 4 h shorter (P = 0.009). Chest drain blood loss was decreased both at 8 (P = 0.01) and 24 h (P = 0.007) postoperatively. Body temperature was lower after surgery and especially on days 2 (P = 0.03) and 3 (P = 0.01). Perioperative creatinine elevation was signif icantly reduced (P = 0.03). Neurological deviations were fewer (P = 0. 01). Brain function assessment revealed reduced plasma levels of S-100 both at termination of cardiopulmonary bypass (P = 0.008) and 7 h lat er (P = 0.04). However, no remediation of memory impairment could be d emonstrated. Conclusions: Cardiopulmonary bypass with covalent bonded heparin attached to the extra-corporeal circuit in combination with a reduced systemic heparin dose seems to reduce safely and effectively t he operative stress to the patient. There were also signs of improved cerebral protection. (C) 1997 Elsevier Science B.V.