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Ann Thorac Surg 1995;60:529
© 1995 The Society of Thoracic Surgeons

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Discussion

Discussion

See also page 525.

DR VINCENT L. GOTT (Baltimore, MD): That was a very nice report. I noticed in your abstract that certainly up through 4 hours in the heparin-coated cases the IL-6 level was about half of that for the noncoated circuits, and yet at 5 hours, they were both the same, around 500 pg/mL. How do you explain that? Is there a chance that some of the heparin is coming off at 5 hours, or how do you explain the fact that at 5 hours they are comparable?

DR STEINBERG: Well, 5 hours is quite a significant period of time to be on bypass.

DR GOTT: Of course it is.

DR STEINBERG: These patients who are in this study group are severely ill patients, and what is probably happening is that there is an element of reperfusion injury or perfusion injury occurring due to ischemia and low flow as well as some contact activation. There is only a finite limit to what you can expect to protect with the system.

DR DAVIS C. DRINKWATER, JR (Los Angeles, CA): Doctor Steinberg, when you did your retrospective analysis did you look at any clinical outcomes such as time to extubation, as that is one of the principal potential benefits?

DR STEINBERG: Unfortunately the sample size of only 20 patients really does not allow for significant outcome analysis; that is something that we want to be able to address adequately by doing a prospective study.

DR SAMUEL V. LICHTENSTEIN (Vancouver, BC, Canada): Doctor Steinberg, with respect to interleukin-8, the prebypass figures in the conventional group are nearly six times as high, a greater difference than after 5 hours of bypass, so how can you conclude that the heparin-coated system is protective?

DR STEINBERG: The statistical analysis method employed here is repeated-measures analysis of variance, so we are really using patients' preoperative values as the baseline or the control. Each patient therefore serves as his or her own control over a period of time.

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