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

Department of Clinical Perfusion, The New York Presbyterian Medical Center, New York, mongero{at}cpmail-am.cis.columbia.edu

J R Beck

Department of Clinical Perfusion, The New York Presbyterian Medical Center, New York

H E Manspeizer

Department of Anesthesiology-Neurology, The New York Presbyterian Medical Center, New York

E J Heyer

Department of Anesthesiology-Neurology, The New York Presbyterian Medical Center, New York

K Lee

Department of Anesthesiology-Neurology, The New York Presbyterian Medical Center, New York

T A Spanier

Department of Cardiothoracic Surgery, The New York Presbyterian Medical Center, New York

C R Smith

Department of Cardiothoracic Surgery, The New York Presbyterian Medical Center, New York

A prospective randomized trial was used to study the incidence of cerebral dysfunction in patients undergoing cardiopulmonary bypass (CPB) with heparin-bonded vs non-heparin-bonded circuits. Although the etiology of postoperative cerebral dysfunction is controversial, activation of the systemic inflammatory response may play a role.

After institutional approval and informed written consent, 39 elective coronary artery bypass (CABG) patients were studied. A battery of neuropsychometric tests (NPMTs) was performed preoperatively, and 5 days and 6 weeks postoperatively. Significant change in NPMT performance was defined as a 25% or greater decrease in postoperative performance, compared to baseline. The number of abnormal tests per patient was calculated. Analysis using the Mann-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 patients randomized to non-heparin-bonded circuits. Patients exposed to heparin-bonded circuits had fewer abnormal tests (>1 abnormal test) at 6 weeks (36 vs 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 surgical patients.

Perfusion, Vol. 16, No. 2, 107-111 (2001)
DOI: 10.1177/026765910101600204


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