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Ann Thorac Surg 2000;70:191-196
© 2000 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, Tisch Hospital, New York University School of Medicine, New York, New York, USA
b Division of Pediatric Cardiology, Tisch Hospital, New York University School of Medicine, New York, New York, USA
Address reprint requests to Dr Grossi, Department of Surgery, New York University Medical Center, 530 First Ave, Suite 9V, New York, NY 10016
e-mail: grossi{at}cv.med.nyu.edu
Background. Heparin-coated circuits reduce the inflammatory response to cardiopulmonary bypass in adult patients; however, little is known about its effects in the pediatric population. Two studies were performed to assess this 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 randomized fashion. Respiratory function and blood product utilization were recorded.
Results. In the pilot study, heparin-bonded circuit patients had less complement 3a (p < 0.001) and interleukin-8 (p < 0.05) compared with uncoated cardiopulmonary bypass circuit patients. The randomized study revealed that the heparin-bonded circuit was associated with reduced complement 3a (p = 0.02). Multiple variable analysis revealed that the following postoperative variables were increased with bypass time (p = 0.01) and diminished with heparin-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 complement during cardiopulmonary bypass and lower interleukin levels postbypass; they were also associated with improved pulmonary and coagulation function. Heparin-bonded circuits ameliorate the systemic inflammatory response in pediatric patients from cardiopulmonary bypass.
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