Two prospective, randomized studies were performed to definitively evaluate the safety and efficacy of heparin- bonded circuits in patients undergoing primary coro nary artery bypass graft surgery and to clarify the effect of anticoagulation protocol on clinical and neurologic outcomes. These studies showed that the use of heparin- bonded circuits with lower anticoagulation results in markedly improved clinical outcomes in patients under going primary coronary artery bypass graft surgery with a reduction in both clinical and microscopic throm boembolic risks. The mechanisms by which heparin- bonded circuits affect clinical and neurologic outcomes are explored.
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References
1.
Gu YJ, van Oeveren W., Akkerman C., et al: Heparin-coated circuits reduce the inflammatory response to cardiopulmonary bypass. Ann Thorac Surg55:917-922, 1993
2.
Ovrum E., Mollnes TE, Fosse E., et al: High and low heparin dose with heparin-coated cardiopulmonary bypass circuits: Activation of complement and granulocytes. Ann Thorac Surg60:1755-1761. 1995
3.
Edmunds Jr, LH: Surface-bound heparin-panacea or peril? Ann Thorac Surg58:285-286, 1994
4.
von Segesser LK , Weiss BK, Pasic M., et al: Risk and benefits of low systemic heparinization during open heart operations. Ann Thorac Surg58:391-398, 1994
5.
Ovrum E., Holen EA, Tangen G., et al: Completely heparinized cardiopulmonary bypass and reduced systemic heparin: clinical and hemostatic effects. Ann Thorac Surg60:365-371, 1995
6.
Aldea GS, Doursounian M., O'Gara P., et al: Heparin-bonded circuits with a reduced anticoagulation protocol in primary CABG: A prospective, randomized study. Ann Thorac Surg62:410-418, 1996
7.
Aldea GS, O'Gara P., Treanor P., et al: Effect of anticoagulation protocol on clinical outcomes in patients undergoing CABG with heparin-bonded circuits. Ann Thorac Surg65:425-433, 1998
8.
Edmunds Jr, LH: Surface bound heparin-panacea or peril? Ann Thorac Surg58:285-286, 1994
9.
Mahana EP, Blumenthal JA, White WD: Defining neuropsychological defecits after coronary artery surgery. Ann Thorac Surg61:1342-1347,1996
10.
Murkin JM, Newman SP, Stump DA, et al: Statement on assessment of neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg59:1289-1295, 1995
11.
Ovrum E., Mollnes TE, Fosse E., et al: High and low heparin dose with heparin-coated cardiopulmonary bypass circuits: activation of complement and granulocytes. Ann Thorac Surg60:1755-1761, 1995
12.
Roach GW, Kanchuger M., Mangano CM, et al: Adverse cerebral outcomes after coronary artery surgery. N Engl J Med335:1857-1863,1996
13.
Pocock SJ, Henderson RA, Rickards AF, et al: Meta-analysis of randomized trials comparing angioplasty with bypass surgery. Lancet346:1184-1189, 1995
14.
Babikian VL , Hyde C., Pochay V., et al: Clinical correlates of high-intensity transient signals detected on transcranial Doppler sonography in patients with cerebrovascular disease. Stroke25:1570-1573, 1994
15.
Gavrilescu T.Babikian VL, Cantelmo NL, et al: Cerebral embolism during carotid endarterectomy . Am J Surg170:159-164, 1995
16.
Ovrum E., Mollnes TE, Fosse E., et al: High and low heparin dose with heparin-coated cardiopulmonary bypass circuits: activation of complement and granulocytes. Ann Thorac Surg60:1755-1765, 1995
17.
Pugsley W., Klinger L., Paschalis C., et al: The impact of microemboli during cardiopulmonary bypass on neuropsychological function. Stroke25:1393-1399, 1994
18.
Barbut D., Lo YW, Gold JP, et al: Impact of embolization during coronary artery bypass grafting on outcome and length of stay. Ann Thorac Surg63:998-1002, 1997
19.
Stump DA: Emboli and brain function during bypass. Proceed AmAcad Cardiovasc Perf17:37-43, 1996
20.
Murkin JM, Baird DL, Martzke JS, et al: Long-term neurological and neuropsychological outcomes 3 years after coronary artery surgery. Anesth Analg82:S328, 1996
21.
Brooker RF, Brown WR, Moody DM, et al: Cardiotomy suction: A major source of brain lipid emboli during cardiopulmonary bypass. Ann Thorac Surg65:1651-1655, 1998
22.
Westaby S.: Organ dysfunction after cardiopulmonary bypass. A systemic inflammatory response reaction initiated by the extracorporeal circuit. Intensive Care Med13:89-95, 1987
23.
Colman RW: Platelet and neutrophil activation during cardiopulmonary bypass. Ann Thorac Surg49:32-34, 1990
24.
Aranki SF, Rizzo RJ, Adams DH, et al: Single-clamp technique, an important adjunct to myocardial and cerebral protection in coronary operations. Ann Thorac Surg58:296-302, 1994
25.
Aldea GS, Lilly K., Gaudiani JM, et al: Heparin-bonded circuits improve clinical outcomes in patients undergoing emergency coronary artery bypass grafting. J Card Surg12:389-397, 1997
