Heparin-bonded circuits with a reduced anticoagulation protocol in primary CABG: a prospective, randomized study

Aldea, Gabriel S.; Doursounian, Mheir; O'Gara, Paul; Treanor, Patrick R.; Shapira, Oz M.; Lazar, Harold L.; Shemin, Richard J.

doi:10.1016/0003-4975(96)00249-4

Cited by 130 publications

(65 citation statements)

References 28 publications

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“…Furthermore, in many of these trials, cardiotomy suction and non-heparin-bonded circuits were used in the on-pump CABG patients; these factors are known to increase complement activation and contribute to the inflammatory response. 42,43 Avoiding cardiotomy suction and using heparinbonded or miniaturized circuits limit complement activation and negate the detrimental effects of CPB.…”

Section: Inflammatory Responses and Biomarkersmentioning

confidence: 99%

Should Off-Pump Coronary Artery Bypass Grafting Be Abandoned?

Lazar

2013

Circulation

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406O ne of the most controversial areas of cardiac surgery has been whether off-pump coronary artery bypass graft (OPCAB) surgery is superior to traditional on-pump coronary artery bypass graft (CABG) surgery. On-pump CABG surgery has been an effective, safe, and time-proven technique and is the gold standard with which all other surgical revascularization methods have been compared. However, performing coronary revascularization on cardiopulmonary bypass (CPB) can result in myocardial ischemic injury, neurocognitive deficits, and strokes and activate inflammatory pathways that contribute to pulmonary, renal, and hematologic complications. OPCAB offered a promising alternative strategy that had the potential to decrease perioperative morbidity, mortality, and cost by eliminating CPB. In fact, throughout Asia and particularly in India, 95% of CABG surgery is performed offpump. In North America, OPCAB procedures peaked at 25% in 2004 and have declined steadily since that time.1 It is a more technically demanding procedure and results in less complete revascularization. There is growing concern that OPCAB is associated with reduced long-term graft patency and increased need for revascularization procedures and results in inferior long-term survival compared with traditional on-pump CABG surgery.In view of these concerns, should OPCAB be abandoned? The purpose of this review is to examine clinical data that most accurately compare the advantages and disadvantages of OPCAB to determine what, if any, role it should have in the practice of surgical coronary artery revascularization. To reach these conclusions, retrospective nonrandomized, prospective randomized, and meta-analyses trials will be reviewed. The effect of incomplete revascularization and conversion to conventional CABG will be examined. The relationship between OPCAB and the inflammatory response, neurological and cognitive changes, and quality of life will be studied, and the impact of OPCAB on sex, renal transplant recipients, and elderly patients will be determined. Retrospective StudiesRetrospective studies were largely single center and lacked randomization. Surgeons who were more skilled in OPCAB were more likely to perform these procedures. Hence, there was a significant selection bias. In most studies, the intentionto-treat principle was not honored. Therefore, if a patient was converted to an on-pump CABG, an adverse outcome associated with this patient would be attributed to the on-pump CABG and not the originally planned OPCAB. Earlier studies may have lacked proper stabilizing equipment and intracoronary perfusion devices. Many trials reported only short-term outcomes. The retrospective studies discussed in this section generally involve >1 surgeon, had larger sample sizes to detect statistically significant differences in clinical outcomes, and contained long-term data.One of the largest databases used to compare outcomes between OPCAB and on-pump CABG techniques involved the New York State Registry for CABG Surgery. Racz and coworkers 2 first...

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Section: Inflammatory Responses and Biomarkersmentioning

confidence: 99%

Should Off-Pump Coronary Artery Bypass Grafting Be Abandoned?

Lazar

2013

Circulation

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“…The lower systemic heparin dose might subsequently lead to reduced bleeding and less need for blood transfusions [41][42][43] . In a large multicenter study of patients at higher risk, heparincoated circuits were associated with a shorter intensive care unit and postoperative hospital stay and had a protective effect on lung and kidney function [ 44 ] .…”

Section: Tubingmentioning

confidence: 99%

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Anastasiadis¹,

Antonitsis²,

Argiriadou³

2012

Principles of Miniaturized ExtraCorporeal Circulation

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“…2 The detrimental effects of complement activation during CPB have prompted the development of interventions such as leukocyte filters and heparin-bonded circuits in an attempt to inhibit complement activation and improve patient outcomes. [5][6][7] Another approach is to directly inhibit complement activation with pharmacologic agents. Soluble complement receptor type 1, designated TP10, is a potent inhibitor of the classical and alternative complement pathways.…”

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confidence: 99%

Soluble Human Complement Receptor 1 Limits Ischemic Damage in Cardiac Surgery Patients at High Risk Requiring Cardiopulmonary Bypass

et al. 2004

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the TP10 Cardiac Surgery Study GroupBackground-This study was undertaken to determine whether soluble human complement receptor type 1 (TP10), a potent inhibitor of complement activation, would reduce morbidity and mortality in high-risk patients undergoing cardiac surgery on cardiopulmonary bypass (CPB). Methods-This was a randomized multicenter, prospective, placebo-controlled, double-blind study in which 564 high-risk patients undergoing cardiac surgery on CPB received an intravenous bolus of TP10 (1, 3, 5, 10 mg/kg) or placebo immediately before CPB. The primary endpoint was the composite events of death, myocardial infarction (MI), prolonged (Ն24 hours) intra-aortic balloon pump support (IABP), and prolonged intubation. Results-TP10 significantly inhibited complement activity after 10 to 15 minutes of CPB and this inhibition persisted for 3 days postoperatively. However, there was no difference in the primary endpoint between the 2 groups (33.7% placebo versus 31.4% TP10; Pϭ0.31). The primary composite endpoint was, however, reduced in all male TP10 patients by 30% (Pϭ0.025). TP10 reduced the incidence of death or MI in males by 36% (Pϭ0.026), the incidence of death or MI in CABG males by 43% (Pϭ0.043) and the need for prolonged IABP support in male CABG and valve patients by 100% (Pϭ0.019). There was, however, no improvement seen in female TP10 patients. There were no significant differences in adverse events between the groups. Conclusion-TP10 effectively inhibits complement activation during CPB; however, this was not associated with an improvement in the primary endpoint of the study. Nevertheless, TP10 did significantly decrease the incidence of mortality and MI in male patients.

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Heparin-bonded circuits with a reduced anticoagulation protocol in primary CABG: a prospective, randomized study

Cited by 130 publications

References 28 publications

Should Off-Pump Coronary Artery Bypass Grafting Be Abandoned?

Should Off-Pump Coronary Artery Bypass Grafting Be Abandoned?

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Soluble Human Complement Receptor 1 Limits Ischemic Damage in Cardiac Surgery Patients at High Risk Requiring Cardiopulmonary Bypass

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