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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 806-813, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
V Videm, JL Svennevig, E Fosse, G Semb, A Osterud and TE Mollnes
Complement activation after cardiopulmonary bypass is correlated with
postoperative organ dysfunction. Heparin coating of the entire blood-
contact surface of the cardiopulmonary bypass circuit has proved to reduce
complement activation in vitro. A membrane oxygenator and tubing setup
coated with functionally active heparin was compared with an uncoated,
otherwise identical setup in 20 patients undergoing routine coronary bypass
operations. The concentrations of C3 activation products and the terminal
complement complex were measured in sensitive and specific enzyme
immunoassays. Peak concentrations of C3 activation products were 90.1 (74.7
to 107.4) AU/ml (medians and 95% confidence intervals) and 52.4 (35.7 to
76.4) AU/ml with the uncoated and coated setups, respectively (p = 0.02).
The corresponding concentrations of the terminal complement complex were
26.2 (20.1 to 37.5) AU/ml and 13.7 (11.1 to 25.1) AU/ml (p = 0.03). Blood
loss from the mediastinal drains during the first 12 postoperative hours
was 533 (416 to 975) ml in patients treated with the uncoated setup and 388
(313 to 579) ml in the coated treatment group (p = 0.06) and was
significantly correlated with peak concentrations of the terminal
complement complex (p = 0.01). There were no differences in neutrophil
counts nor platelet numbers between the treatment groups. The approximate
45% reduction in complement activation with the heparin-coated
cardiopulmonary bypass device indicates a substantial improvement of
biocompatibility.
ARTICLES
Reduced complement activation with heparin-coated oxygenator and tubings in coronary bypass operations
University of Oslo Institute for Experimental Medical Research, Norway.
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C B. Mahoney Heparin-bonded circuits: clinical outcomes and costs Perfusion, May 1, 1998; 13(3): 192 - 204. [Abstract] [PDF]
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S. Ashraf, Y. Tian, D. Cowan, A. Entress, P. G. Martin, and K. G. Watterson Release of Proinflammatory Cytokines During Pediatric Cardiopulmonary Bypass: Heparin-Bonded Versus Nonbonded Oxygenators Ann. Thorac. Surg., December 1, 1997; 64(6): 1790 - 1794. [Abstract] [Full Text]
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H. L. Lazar, X. Zhang, T. Hamasaki, C. A. Memmelo, P. Treanor, S. Rivers, G. S. Aldea, S. A. Bernard, and R. J. Shemin Heparin-Bonded Circuits Decrease Myocardial Ischemic Damage: An Experimental Study Ann. Thorac. Surg., June 1, 1997; 63(6): 1701 - 1705. [Abstract] [Full Text]
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S. Bannan, A. Danby, D. Cowan, S. Ashraf, and P. G. Martin Low Heparinization With Heparin-Bonded Bypass Circuits: Is It a Safe Strategy? Ann. Thorac. Surg., March 1, 1997; 63(3): 663 - 668. [Abstract] [Full Text]
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C. Baufreton, P. Le Besnerais, P. Jansen, J. P. Mazzucotelli, C. R. Wildevuur, and D. Y Loisance Clinical outcome after coronary surgery with heparin-coated extracorporeal circuits for cardiopulmonary bypass Perfusion, November 1, 1996; 11(6): 437 - 443. [Abstract] [PDF]
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H. t. Velthuis, P. G. M. Jansen, C. E. Hack, L. Eijsman, and C. R. H. Wildevuur Specific Complement Inhibition With Heparin-Coated Extracorporeal Circuits Ann. T |
