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A Journal on Internal Medicine

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Panminerva Medica 1999 September;41(3):193-8


language: English

Heparin-coat­ed cir­cuits ­reduce com­ple­ment acti­va­tion and inflam­ma­to­ry ­response to car­di­o­pul­mo­nary ­bypass

Tamim M., Dem­ir­cin M., Guven­er M., Pek­er O., Yil­maz M.

From the Faculty of Medicine, Hacettepe University Thoracic and Cardiovascular Surgery Department Ankara, Turkey


Background. Clinical pro­ce­dures involv­ing extra­cor­po­real ­blood cir­cu­la­tion are poten­tial­ly com­pli­cat­ed by the inter­ac­tion of var­i­ous ­blood ­systems ­with for­eign sur­fac­es. In car­di­o­pul­mo­nary ­bypass, expo­sure of ­blood to syn­thet­ic sur­fac­es gen­er­al­ly ­leads to acti­va­tion of cel­lu­lar and humo­ral ­blood ­systems ­with acti­va­tion of com­ple­ment cas­cade. This reac­tion can be asso­ciat­ed ­with a varie­ty of ­postoper­a­tion clin­i­cal com­pli­ca­tions ­such as ­increased pul­mo­nary cap­il­lary perme­abil­ity, anaph­y­lac­tic reac­tions and var­i­ous ­degrees of ­organ fail­ure ­which con­trib­utes to mor­tal­ity in rou­tine car­diac oper­a­tions. Application of bio­com­pat­ible mate­ri­als in an extra­cor­po­real cir­cuit mod­i­fies the nor­mal pat­tern of ­blood acti­va­tion, and there­fore poten­tial­ly may ­reduce clin­i­cal com­pli­ca­tions in rou­tine car­diac sur­gery.
Methods. To eval­u­ate wheth­er the use of hepar­in ­coat­ed extra­cor­po­real cir­cuits ­could ­reduce ­this acti­va­tion pro­cess we per­formed a ­study on for­ty cor­o­nary ­artery ­bypass ­graft ­patients per­fused ran­dom­ly ­with hep­ar­in-coat­ed cir­cuits (Duraflo II, n=20) or ­with non-coat­ed cir­cuits (De Bakey roll­er ­pump, con­trol n=20). Standardized hep­a­rin­iza­tion was main­tained for ­both ­groups of ­patients dur­ing car­di­o­pul­mo­nary ­bypass.
Results. The use of hep­ar­in-coat­ed cir­cuits result­ed in reduc­tion of system­ic leu­ko­cyte acti­va­tion of car­di­o­pul­mo­nary ­bypass reflect­ed by ­reduced leu­ko­cyte and neu­troph­il ­counts 24 ­hours ­after oper­a­tion (p<0.05). Furthermore, ­blood sam­ples tak­en ­from ­both the ­right and ­left atri­um ­after reper­fu­sion ­revealed ­that the dif­fer­enc­es in neu­troph­il ­counts ­between the ­right and ­left atri­um ­occur ­less in the hep­ar­in-coat­ed cir­cuit in con­trast to the con­trol ­group (p<0.05). The pat­tern of com­ple­ment acti­va­tion, prob­ably initiat­ing ­this inflam­ma­to­ry reac­tion, was mod­i­fied by hep­ar­in coat­ing in two dif­fer­ent ­aspects. There was a sig­nif­i­cant reduc­tion of C3 dur­ing and ­after car­di­o­pul­mo­nary ­bypass in ­patients per­fused ­with hep­ar­in coat­ed cir­cuits as com­pared ­with the con­trol ­group, ­also ­there was reduc­tion of C4 ­after pro­ta­mine admin­is­tra­tion in the ­same ­groups (p<0.05). The reduc­tions in ­blood and com­ple­ment acti­va­tion ­with hep­ar­in-coat­ed cir­cuit indi­cate a sub­stan­tial improve­ment in bio­com­pat­ibil­ity, and con­se­quent­ly reduc­ing clin­i­cal com­pli­ca­tions asso­ciat­ed ­with car­di­o­pul­mo­nary ­bypass.
Conclusions. In con­clu­sions ­using the Duraflo II hep­ar­in-coat­ed cir­cuit in ­open ­heart sur­gery can ­reduce the com­ple­ment acti­va­tion and inflam­ma­to­ry ­response to car­di­o­pul­mo­nary ­bypass.

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