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Eur J Cardiothorac Surg 2007;31:1058-1069. doi:10.1016/j.ejcts.2007.01.029
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Review

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

^a National Heart & Lung Institute, Imperial College of Science, Technology and Medicine, Department of Cardiothoracic Surgery, The Heart Hospital, UCLH, London, UK
^b Department of Biosurgery & Surgical Technology, Imperial College of Science, Technology and Medicine, London, UK
^c National Heart & Lung Institute, Imperial College of Science, Technology and Medicine, Department of Cardiothoracic Surgery, Harefield Hospital, Middlesex, UK
^d National Heart & Lung Institute, Imperial College of Science, Technology and Medicine, Department of Cardiothoracic Surgery, St Mary's Hospital, London, UK
^e Department of Cardiothoracic Surgery, New Cross Hospital, Wolverhampton, UK

Received 24 July 2006; received in revised form 30 December 2006; accepted 15 January 2007.

^_* Corresponding author. Address: The Heart Hospital, UCLH, 16-18 Westmoreland Street, London W1G 8PH, UK. Tel.: +44 207 5738888. (Email: omangoush{at}yahoo.co.uk).

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.

Key Words: Heparin-bonded circuit • Cardiopulmonary bypass • Perfusion • Meta-analysis

Abbreviations: HBCs = heparin-bonded circuit • NHBCs = nonheparin-bonded circuit • LOS = length of stay • AF = atrial fibrillation • CI = confidence intervals • ICU = intensive care unit • RCT = randomized controlled trial • OR = odds ratio • WMD = weighted mean difference • MeSH = medical subject headings • PRC = packed red cells • FFP = fresh frozen plasma • QUORUM = quality of reporting of meta-analyses • MI = myocardial infarction • CABG = coronary artery bypass grafting

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