Cardiac surgical patients exposed to heparin-bonded circuits develop less postoperative cerebral dysfunction than patients exposed to non-heparin-bonded circuits

A prospective randomized trial was used to study the incidence of cerebral dysfunction in patients undergoing cardiopulmonary bypass (CPB) with hepari n-bonded vs non-heparin-bonded circuits. Although the etiology of postopera tive cerebral dysfunction is controversial. activation of the systemic infl ammatory response may play a role. After institutional approval and informed written consent. 39 elective coro nary artery bypass (CABG) patients were studied. A battery of neuropsychome tric tests (NPMTs) was performed preoperatively, and 5 days and 6 weeks pos toperatively. Significant change in NPMT performance was defined as a 25% o r greater decrease in postoperative performance, compared to baseline. The number of abnormal tests per patient was calculated. Analysis using the Man n-Whitney rank test was performed for the first follow-up. Patients randomized to heparin-bonded circuits had fewer abnormal NPMTs (>1 abnormal test) on postoperative day 5 (58 vs 70%, n=19 and 20) than patien ts randomized to non-heparin-bonded circuits. Patients exposed to heparin-b onded circuits had fewer abnormal tests (>1 abnormal test) at 6 weeks (36 v s 63%. n=14 and 16). Results suggested that the attenuation of systemic inflammation by heparin- bonded CPB circuits may lower the incidence of cerebral injury in cardiac s urgical patients.