Heparin-coated circuits reduce occult myocardial damage during CPB: a randomized, single blind clinical trial

Objectives: Cardiopulmonary bypass is associated with a diffuse systemic in flammatory response that can cause considerable morbidity, including organ dysfunction and bleeding. Heparin-coated circuits have been shown to give a reduced inflammatory response with clinical benefits during open-heart sur gery. However, the effects., on lipid peroxidation. neutrophil activation a nd myocardial ischemic damage in the human have remained unknown. Methods: In a randomized single blind trial, complement activation. neutrophil count s, malondialdehyde, and cardiac enzymes were studied in 39 patients undergo ing open-heart surgery. Two groups were perfused with cardiopulmonary bypas s circuits with (n = 20) or without heparin-coating (n = 19). Results: The different complement factors (C3, C4, C3d, C3d/C3 and the C-function), neut rophil levels, MDA and the cardiac enzyme levels were comparable before CPB was started and significantly increased in both groups during bypass. Ther e were significant intergroup differences in the neutrophil levels and MDA after reperfusion (P < 0.0001). Furthermore. significant positive correlati ons between the lipid peroxidation, expressed as MDA levels, and the levels of neutrofils and the cardiac enzyme, CK-MB were seen within the groups. C onclusions: Heparin coated circuits did lead to a decreased neutrophil resp onse and MDA level. The correlations between CK-MB and neutrophil and MDA l evels suggest neutrophil activation leading to lipid peroxidation that may influence myocardial damage. Heparin coating improved biocompatibility and was associated with less occult myocardial ischemic damage in patients unde rgoing open heart surgery. (C) 2000 Elsevier Science B.V. All rights reserv ed.