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Platelet preservation during cardiopulmonary bypass with iloprost and Duraflo-II heparin-coated surfaces
G M Palatianos1, M K Dewanjee, W Smith
1Division of Thoracic and Cardiovascular Surgery, University of Miami School of Medicine, Florida 33101.
Insights
Surface heparinization and Iloprost preserve platelet counts during cardiopulmonary bypass (CPB). This method enhances platelet preservation in CPB circuits, crucial for patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Biomaterials
Background:
- Cardiopulmonary bypass (CPB) can lead to significant platelet loss.
- Maintaining platelet function during CPB is critical for hemostasis and patient recovery.
- Surface-modified extracorporeal circuits aim to mitigate adverse effects on blood components.
Purpose of the Study:
- To evaluate the efficacy of temporary platelet inhibition combined with surface heparinization for platelet preservation during CPB.
- To test the hypothesis that this combined approach can reduce platelet activation and loss.
Main Methods:
- Nine Yorkshire pigs underwent a 3-hour CPB procedure.
- Platelets were labeled with Indium-111 tropolone for tracking.
- Two groups were studied: Group A (systemic heparinization) and Group B (surface heparinization with Iloprost).
- Platelet counts and radioactivity in the oxygenator were measured.
Main Results:
- Group A pigs showed significant platelet count decline (e.g., 69.0% at 3 hours, p < 0.05).
- Group B pigs maintained platelet counts above 90% of pre-CPB values.
- Radioactivity in the oxygenator was significantly lower in Group B (0.73%) compared to Group A (2.82%, p = 0.0541).
Conclusions:
- Surface heparinization combined with Iloprost effectively preserves platelet counts during CPB in a porcine model.
- This strategy reduces platelet sequestration within the CPB circuit.
- The findings suggest a promising approach for improving platelet management during cardiac surgery.
Abstract:
To test the hypothesis that temporary platelet inhibition during cardiopulmonary bypass (CPB) with surface heparinized systems may result in platelet preservation, nine Yorkshire pigs were placed on CPB for 3 hours. Platelet labeling was done in all pigs with Indium-111 tropolone. CPB was instituted with a roller pump, a hollow fiber membrane oxygenator (Bentley CM-50 [Baxter-Bentley Laboratories, Irvine, CA]), and an arterial filter. The extracorporeal perfusion systems were surface-coated with the Duraflo-II heparin complex. Group A pigs (n = 5) were systemically heparinized (activated coagulation time longer than 400 sec). Group B pigs (n = 4) were placed on CPB without systematic heparinization, but have received the stable prostacyclin-analog Iloprost (ZK36374) at 1 ng/kg/min i.v. from 30 min before and during CPB. Platelet counts declined in group A pigs at 5 min, 1 hr, 2 hr, and 3 hr of CPB to 79.8% (mean), 66.5%, 71.3%, and 69.0% of pre-CPB values, respectively (p less than 0.05). In group B pigs, mean platelet count during CPB was higher than 90% of control value. Percentage of injected radioactivity detected in the oxygenator was 2.82% in group A pigs versus 0.73% in group B pigs (p = 0.0541). Surface heparinization with the Duraflo II heparin coating complex in combination with Iloprost-induced temporary platelet inhibition resulted in platelet count preservation during CPB in the pig model.