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Active or passive bio-coating: does it matters in extracorporeal circulation?

S Jacobs1, F De Somer, G Vandenplas

  • 1Department of Anaesthesia, University Hospital Gent, Gent, Belgium.

Perfusion
|July 2, 2011
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Combining phosphorylcholine coating with unfractionated heparin did not improve outcomes in cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG). Complement activation was higher with the combined coating, suggesting no added benefit for this patient group.

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Area of Science:

  • Biomaterials Science
  • Cardiovascular Surgery
  • Immunology

Background:

  • Surface coatings for cardiopulmonary bypass (CPB) include bioactive (heparin, nitric oxide) and biopassive (albumin, polyethyleneoxide, phosphorylcholine) types.
  • Combining haemocompatible coatings with aspiration techniques can attenuate coagulation and complement cascades, improving platelet preservation.
  • This study investigates if combining a bioactive (unfractionated heparin) with a biopassive (phosphorylcholine) coating offers synergistic benefits.

Purpose of the Study:

  • To evaluate the efficacy of a combined unfractionated heparin and phosphorylcholine coating on CPB circuits.
  • To determine if this combined coating offers additional benefits over phosphorylcholine alone in elective CABG patients.
  • To assess the impact on coagulation, complement activation, and platelet preservation.

Main Methods:

  • Prospective randomized study of 30 elective coronary artery bypass grafting (CABG) patients.
  • Control group (PC): CPB circuit coated with phosphorylcholine (PC).
  • Study group (XPC): CPB circuit with unfractionated heparin embedded in a PC matrix.

Main Results:

  • No significant differences in haemolytic index, thrombin-anti-thrombin complex, IL-6, IL-10, or blood loss between groups.
  • Platelet factor 4 (PF4) concentrations increased similarly in both groups.
  • Terminal complement complex (TCC) generation was significantly higher in the XPC group compared to the PC group, particularly after aortic cross-clamp release and at CPB completion.

Conclusions:

  • Combining phosphorylcholine with unfractionated heparin provides no additional benefit for elective CABG patients.
  • The combined coating resulted in significantly higher complement activation.
  • Massive hemodilution may contribute to enhanced complement activation during CPB.