Ann Thorac Surg 1999;67:1000
© 1999 The Society of Thoracic Surgeons
Commentary
Erik Fosse, MD, PhDa
a The Interventional Centre, Rikshospitalet, 0027 Oslo, Norway
Invited commentary
Since heparin-treated cardiopulmonary bypass surfaces were introduced in the early 1980s, several studies demonstrated reduction in complement and neutrophil activation and in coagulation when heparin-treated systems were used. In several clinical trials the heparin-treated system allowed reduction in the systemic heparinization, indicating improved biocompatibility. However, studies of low-risk patients failed to show improved clinical outcome associated with the use of heparin-treated circuits, mainly because coronary operations on cardiopulmonary bypass in low-risk patients already is associated with a low complication rate. In this very interesting multicenter study of 886 high-risk patients, Ranucci and coworkers stratified the patients according to different risk factors and documented that for certain risk factor groups, the complication rate can indeed be reduced by the use of heparin-treated surfaces.
The effects of heparin coating were most notable in patients with chronic obstructive pulmonary disease, in diabetics, and in patients who had mitral valve procedures. The pulmonary and renal complications were reduced. Pulmonary complications and the development of the adult respiratory disease syndrome postoperatively is associated with complement and granulocyte activation, as in experimental models—inhibition of complement activation might protect against pulmonary dysfunction after a standardized trauma.
The present study provided convincing clinical data supporting what previous immunologic studies have indicated, that heparin-treated cardiopulmonary systems could reduce postoperative morbidity. Furthermore, the fact that there was an overall significant difference between the groups with respect to severely impaired clinical outcome (defined as stay in the intensive care unit for more than 5 days or fatal outcome) might mean reduced costs when heparin-treated circuits are used in high-risk patients.
Related Article
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Heparin-coated circuits for high-risk patients: a multicenter, prospective, randomized trial
- Marco Ranucci, Alessandro Mazzucco, Renzo Pessotto, Giovanni Grillone, Valter Casati, Lorenzo Porreca, Roberto Maugeri, Marco Meli, Paolo Magagna, Silvia Cirri, Pierpaolo Giomarelli, Roberto Lorusso, and Annette de Jong
Ann. Thorac. Surg. 1999 67: 994-1000.
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