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Eur J Cardiothorac Surg 1999;16:206-210
© 1999 Elsevier Science NL

Transfusion after coronary artery bypass surgery: the impact of heparin-bonded circuits

^a Carlson School of Management, University of Minnesota, 3-285 CSOM Building, 321-19th Avenue S, Minneapolis, MN 55455, USA
^b Christiana Care Health Services, Newark, DE, USA

Corresponding author. Tel.: +1-612-6249013 or 6465296; fax: +1-651-6446506
e-mail: cmahoney{at}csom.umn.edu

Objective: To identify the impact of heparin bonded (Carmeda®) circuits on the need for transfusion of packed red blood cells (PRBC) after CABG independent of the influence of patient, procedural, and surgical experience variables. Methods: A prospective, randomized trial examined the impact of heparin-bonded circuits in 210 patients undergoing coronary artery bypass surgery at Medical Center of Delaware (Christiana Care Health Services). Patients were randomized to either non-bonded circuits or heparin-bonded (Carmeda®) circuits. There were no significant differences in patient characteristics between the treatment and control group. A multivariate analysis was performed to identify the independent predictors of both the need for transfusion (logistic) and number of units of PRBC transfused (OLS). Results: The only significant (P<0.05) independent predictors of need for transfusion were gender (odds ratio (OR)=0.35 for males), use of anticoagulants prior to surgery (OR=2.09), cross-clamp time (OR=1.03 for each extra minute), and use of heparin-bonded circuits (OR=0.50 for patients in the heparin-bonded; Carmeda®, circuit group). The only significant independent predictors of number of PRBCs were anticoagulants prior to surgery, cross-clamp time, catheterization procedure on the same day, body surface area, and use of heparin-bonded circuits. Other patient demographic variables, comorbidities, and surgical variables were not significant independent predictors of the need for transfusion or the number of units transfused. Conclusions: Several factors influence the probability of transfusion that patients face following coronary artery bypass surgery. The probability of transfusion is 50% less and the number of PRBCs transfused are 1.42 units less when heparin-bonded (Carmeda®) circuits are used, adjusted for patient demographics, comorbidities, or surgical variables.

Key Words: Cardiopulmonary bypass • Heparin bonded circuit • Blood transfusion • Clinical outcomes

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