Heparin-coated cardiopulmonary bypass circuit: Clinical effects in pediatric cardiac surgery

Objectives: Heparin-coated cardiopulmonary bypass (CPB) circuits have been reported to reduce complement activation and the inflammatory response asso ciated with CPB. We retrospectively compared patients utilizing heparin-coa ted perfusion circuits with those using noncoated circuits to determine the clinical effects of the different circuits in pediatric cardiac surgery. M ethods: Between July 1995 and July 1997, 203 patients weighing < 10 kg unde rwent cardiac surgery, 153 patients using heparin-coated bypass circuits an d 50 patients using noncoated circuits. The 50 patients operated on with th e noncoated circuit (Group N) were matched to 100 patients operated on with coated circuits (Group H) in age, weight, and type of procedure. Urine out put during bypass, blood products used after bypass, postoperative ventilat ion days, hospital stay, morbidity, and mortality were compared between the se groups. Results: Body weight, perfusion time, and procedure time were no t different between the two groups. Urine output during bypass was notably greater in Group H than in Group hi (11.3 +/- 10.5 mL/kg per hour vs 4.8 +/ - 3.1 mL/kg per hour, respectively, p < 0.0001). Postoperative mechanical v entilation markedly decreased in Group H (Group H vs hi = 2.8 +/- 2.7 days vs 5.1 +/- 7.5 days, respectively, p < 0.05). Red blood cell usage, hospita l stay, morbidity, and mortality were not statistically different, although there was a tendency toward decreased transfusion of red cell and platelet s in Group H (Group H vs N = 61.2 +/- 121.1 mL/kg vs 102.0 +/- 176.7 mL/kg, respectively, in red cell, p = 0.15; and Group H vs hi = 7.9 +/- 13.7 mL/k g vs 13.2 +/- 24.5 mL/kg, respectively, in platelets, p = 0.16). Conclusion s: Patients operated on with the use of heparin-coated circuits had increas ed urine output during bypass and required less time postoperatively on the ventilator. These results suggest a reduction in the acute inflammatory re sponse, capillary leakage, and overall systemic edema. We now routinely use coated circuits on all pediatric pump cases.