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


lingua: Inglese

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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