Impact of heparin bonding on pediatric cardiopulmonary bypass: A prospective randomized study

Background. Heparin-coated circuits reduce the inflammatory response to car diopulmonary bypass in adult patients; however, little is known about its e ffects in the pediatric population. Two studies were performed to assess th is technology's impact on inflammation and clinical outcomes. Methods. In a pilot study, complement and interleukins were measured in 19 patients who had either uncoated cardiopulmonary bypass circuits or heparin -bonded circuits. Subsequently, 23 additional patients were studied in a ra ndomized fashion. Respiratory function and blood product utilization were r ecorded. Results. In the pilot study, heparin-bonded circuit patients had less compl ement 3a (p < 0.001) and interleukin-8 (p < 0.05) compared with uncoated ca rdiopulmonary bypass circuit patients. The randomized study revealed that t he heparin-bonded circuit was associated with reduced complement 3a (p = 0. 02). Multiple variable analysis revealed that the following postoperative v ariables were increased with bypass time (p = 0.01) and diminished with hep arin-bonded circuits: interleukins (p = 0.01), peak airway pressures (p = 0 .05), and prothrombin time (p = 0.03). Conclusions. Heparin-bonded circuits significantly reduce cytokines and com plement during cardiopulmonary bypass and lower interleukin levels postbypa ss; they were also associated with improved pulmonary and coagulation funct ion. Heparin-bonded circuits ameliorate the systemic inflammatory response in pediatric patients from cardiopulmonary bypass. (Ann Thorac Surg 2000;70 :191-6) (C) 2000 by The Society of Thoracic Surgeons.