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Effects of two differently heparin-coated extracorporeal circuits on markers for brain and myocardial dysfunction
Hanne I Flom-Halvorsen1, E Ovrum, F Brosstad
1Oslo Heart Center, Norway. hannef@klinmed.uio.no
Insights
This study compared two cardiopulmonary bypass (CPB) systems, Carmeda Bio-Active Surface (CBAS) and Duraflo II, for brain and myocardial dysfunction markers. Results showed minimal differences, with only neuron-specific enolase (NSE) slightly elevated in the Duraflo II group.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Neuroscience
Background:
- Heparin-coated systems are crucial for cardiopulmonary bypass (CPB).
- Carmeda Bio-Active Surface (CBAS) and Duraflo II are common CPB systems with known differences in immune and cellular effects.
- Limited data exists on their impact on brain and myocardial dysfunction markers.
Purpose of the Study:
- To compare the effects of CBAS and Duraflo II CPB systems on markers of brain and myocardial dysfunction.
- To evaluate S-100B, neuron-specific enolase (NSE), myoglobin, creatine kinase (CK-MB), and troponin-I levels during and after CPB.
- To correlate marker elevation with CPB duration.
Main Methods:
- Prospective randomized trial of 40 patients undergoing coronary bypass grafting with CPB.
- Patients were randomized to either CBAS or Duraflo II circuits.
- Biological markers for brain and myocardial injury were analyzed during and post-CPB.
Main Results:
- Both brain dysfunction markers (S-100B, NSE) and myocardial injury markers (myoglobin, CK-MB, troponin-I) increased during CPB.
- NSE showed a slight, statistically significant elevation in the Duraflo II group post-CPB.
- No significant intergroup differences were observed for S-100B, other cardiac markers, or clinical outcomes.
Conclusions:
- Except for a minor NSE elevation, CBAS and Duraflo II systems showed no significant differences in brain or myocardial dysfunction markers.
- The choice between CBAS and Duraflo II may not critically impact these specific neurological and cardiac injury markers.
- Further research could explore other functional outcomes or long-term effects.
Objective:
The two most commonly used heparin-coated systems for cardiopulmonary bypass (CPB) are the Carmeda Bio-Active Surface (CBAS) (Medtronic, Minneapolis, MN, USA) and the Duraflo II coating (Baxter Healthcare, Irvine, CA, USA). The two surfaces are technically unequal and previous experimental studies have demonstrated disparities in effects on the immune system and blood cells. However, little is known concerning the influence of the two surfaces on markers for brain and myocardial dysfunction.
Methods:
Forty patients undergoing elective, primary coronary bypass grafting with CPB were prospectively randomized to either the CBAS system or the Duraflo II circuit. During and after CPB, biological markers for brain dysfunction and myocardial injury were analysed.
Results:
Both markers for brain dysfunction S-100B and neuron-specific enolase (NSE) increased significantly during CPB (p = 0.01). The elevation during bypass correlated significantly with the duration of CPB (r = 0.39 and r = 0.38, respectively, both p < 0.02). NSE was somewhat more elevated in the Duraflo II group at the end of CPB (p = 0.01) and 5 h after CPB (p = 0.02); for S-100B, there were no intergroup differences. Also, the markers related to myocardial injury, myoglobin and creatine kinase (CK-MB) mass increased during CPB (p = 0.01), while elevation of troponin-I occurred 5 h after CPB (p = 0.01). There were no statistically significant intergroup differences. No significant correlation was seen between the release of cardiac markers and the duration of CPB. The clinical course was similar in both groups.
Conclusions:
Except for a slightly higher elevation of NSE at the end of CPB and 5 h after CPB in the Duraflo II group, there were no significant differences between the CBAS group and the Duraflo II group concerning markers for brain and myocardial dysfunction.
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