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Hyaluronan based heparin free coated open and closed extracorporeal circuits for high risk coronary revascularization

Serdar Gunaydin1, Halil Ibrahim Ucar, Tanzer Serter

  • 1University of Kirikkale-Turkey, Ankara, Turkey. sgunaydin@isnet.net.tr

The Journal of Extra-Corporeal Technology
|February 15, 2011
PubMed

Insights

Using heparin-free coated extracorporeal circuits (ECC) in high-risk patients undergoing coronary revascularization significantly reduces inflammatory responses and improves clinical outcomes, including less blood loss.

Area of Science:

  • Cardiovascular Surgery
  • Biomaterials Science
  • Critical Care Medicine

Background:

  • Extracorporeal circuits (ECC) are essential for cardiopulmonary bypass (CPB) but can trigger inflammatory and thrombotic responses.
  • Coated ECC surfaces, particularly those using hyaluronan-based heparin-free coatings, are designed to mitigate these adverse effects.
  • High-risk patients undergoing coronary revascularization are particularly susceptible to complications associated with CPB.

Purpose of the Study:

  • To compare the inflammatory response and fibrinolytic activation between fully coated and uncoated, and open and closed ECC in high-risk patients.
  • To evaluate the impact of different ECC configurations on myocardial protection and postoperative bleeding.
  • To assess the clinical outcomes, including blood loss and atrial fibrillation rates, associated with heparin-free coated ECC.

Main Methods:

  • A prospective randomized study involving 48 high-risk patients (EuroSCORE ≥ 6) undergoing coronary revascularization.
  • Four perfusion protocols were compared: closed/coated, closed/uncoated, open/coated, and open/uncoated ECC.
  • Blood samples were collected at multiple time points to measure inflammatory markers (IL-6, CD11b/CD18), myocardial damage (CK-MB), and coagulation activation (thrombin-antithrombin).

Main Results:

  • Coated ECC, especially the closed and heparin-free variant, significantly reduced interleukin-6 (IL-6) levels and neutrophil activation (CD11b/CD18) compared to uncoated controls.
  • Myocardial protection was enhanced in coated groups, as indicated by lower creatine kinase M-band (CK-MB) levels in coronary sinus blood.
  • Postoperative hemorrhage was significantly reduced in both open and closed coated ECC groups compared to the control group (510-536 mL vs. 784 mL).

Conclusions:

  • Closed, heparin-free coated ECC effectively minimizes inflammatory response, cytokine release, and neutrophil activation during CPB.
  • The use of coated ECC leads to improved myocardial preservation and reduced postoperative bleeding in high-risk cardiac surgery patients.
  • Heparin-free coated ECC demonstrates potential for improved clinical outcomes, including reduced need for inotropes and lower incidence of atrial fibrillation.

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