Heparin-bonded circuits versus nonheparin-bonded circuits: an evaluation of their effect on clinical outcomes

Abstract

Heparinization of the blood contact surface in cardiopulmonary bypass circuits has been promoted as an important step in the development of open heart surgery. As it decreases the inflammatory response resulting from the extracorporeal circulation, it may have a positive effect on clinical outcomes. This meta-analysis was carried out to examine if heparin-bonded circuits (HBCs) reduce the need for blood products and improve overall clinical outcome. A systematic literature search was performed to identify randomized controlled trials reporting outcomes of HBCs compared with non-HBCs. Primary outcomes assessed were postoperative blood/blood-product transfusion and blood loss. Secondary outcomes included all-cause mortality, acute postoperative myocardial infarction, stroke, re-sternotomy for postoperative bleeding, wound infection, atrial fibrillation, duration of ventilation, intensive care unit (ICU) and hospital-length of stay (LOS). Random effects meta-analytical techniques were applied to identify differences in outcomes between the two groups. Quality of the included studies and heterogeneity were assessed. From an initial review of 762-published studies, 41-randomized trials fulfilled the inclusion criteria, leaving 3434-patients' data for analysis. HBCs significantly decreased the incidence of blood transfusion required (OR=0.8; 95% CI=0.6:0.9, P=0.004). It also significantly decreased re-sternotomy (OR=0.6; 95% CI=0.4:0.8, P=0.002), duration of ventilation (WMD= -1.3h; 95% CI= -1.9:-0.6, P<0.001), ICU-LOS (WMD= -9.3h; 95% CI=-14.7:-3.9, P<0.001) and hospital-LOS (WMD= -0.5 day; 95% CI= -0.9:-0.1, P=0.02). HBCs had no effect on other adverse events evaluated. Although HBCs showed a positive effect on some of the clinical outcomes, we identified only marginal differences for other outcomes. Further evaluation of the cost-effectiveness of this technology is required.

Support time-dependent outcome analysis for veno-venous extracorporeal membrane oxygenation

“…These oxygenators are associated with reduced red blood cell and platelet transfusion requirements and improved gas exchange compared to previously available oxygenators [2]. Further improvements in circuit components are centrifugal pumps with low hemolysis rates and tipto-tip heparin coating of all circuit components, allowing short periods of ECMO support without anticoagulation in clinical situations with high bleeding risks [2,3]. Today, these technological improvements permit the use of ECMO as a percutaneously introduced paracorporeal lung assist enabling ambulation and physical activity in principle [4].…”

Retrospective analysis of outcome data with regards to the use of Phisio®-, Bioline®- or Softline®-coated cardiopulmonary bypass circuits in cardiac surgery

“…There was also a significant difference in favour of the heparin-coated system regarding death, new onset myocardial infarction, stroke, wound infection and atrial fibrillation. 9 Sohn et al 10 showed, in a randomized trial with 73 CABG patients, that heparin-coated and phosphorylcholine-coated circuits induce less inflammatory responses and oxidative stress compared to other circuits. Clinical outcome was not investigated.…”

Circulação extracorpórea em adultos no século XXI: ciência, arte ou empirismo?

“…Moreover, the achieved reduction of inflammatory response has benefic effects on the patient's clinical evolution. Mangoush et al [15] also showed that the substance reduced the ventilation time in 78 minutes, as well as the hospitalization time in 0.5 days. Because of these reductions, the use of the mentioned substance also allows important economy in terms of financial costs.…”