Heparin-Bonded Circuits Versus Non-Heparin-Bonded Circuits: An Evaluation Of Their Effect On Clinical Outcomes.
- Publication Type
- Original research
- Authors
- Omar Mangoush
- Sanjay Purkayastha
- Saleem Haj-Yahia
- James Kinross
- Martin Hayward
- Fabio Bartolozzi
- Ara Darzi
- Thanos Athanasiou
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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 = −1.3 h; 95% CI = −1.9:−0.6, P ≪ 0.001), ICU-LOS (WMD = −9.3 h; 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
Journal
- Title
- Eur J Cardio-thoracSurg. 2007 Jun; 31(6):1058-1069
- Publisher
- --
- Publisher Country
- Palestine
- Publication Type
- Both (Printed and Online)
- Volume
- --
- Year
- 2007
- Pages
- --