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Biocompatibility of heparin-coated membrane oxygenator during cardiopulmonary bypass
1Department of Surgery II, National Defense Medical College, Saitama, Japan.
Insights
Heparin-coated oxygenators in cardiopulmonary bypass (CPB) circuits reduce systemic inflammatory reactions. This biocompatible approach improved platelet recovery and lowered inflammatory markers compared to uncoated oxygenators.
Area of Science:
- Biomedical Engineering
- Cardiovascular Surgery
- Inflammation Research
Background:
- Cardiopulmonary bypass (CPB) circuits can trigger systemic inflammatory responses.
- Assessing biocompatibility is crucial for improving CPB procedures.
Purpose of the Study:
- To evaluate the biocompatibility of a heparin-coated oxygenator during CPB.
- To compare systemic inflammatory reactions between heparin-coated and uncoated oxygenators.
Main Methods:
- A randomized study involving 14 coronary artery bypass surgery patients.
- Two groups: heparin-coated (Group H) and uncoated (Group C) membrane oxygenators.
- Measurement of inflammatory markers (platelets, prostaglandin, complement, granulocyte elastase) pre-, during, and post-CPB.
Main Results:
- Group H showed better platelet recovery post-CPB compared to Group C.
- Significantly lower levels of platelet factor 4 and Thromboxane-B2 (TXB2) in Group H post-protamine administration.
- Reduced plasma concentrations of granulocyte elastase in Group H throughout the post-CPB period.
Conclusions:
- Heparin-coated oxygenators enhance the biocompatibility of CPB circuits.
- This leads to a reduced inflammatory response and improved patient outcomes.
Abstract:
The biocompatibility of the cardiopulmonary bypass (CPB) circuit, in which an oxygenator is solely heparinized, was assessed by systemic inflammatory reactions as an indicator during CPB. Fourteen patients, 11 males and 3 females, underwent coronary artery bypass surgery and were randomly divided into 2 groups of 7 patients each. For the heparin-coated oxygenator group (Group H), a heparin-coated membrane oxygenator was used in the CPB circuit, and in the control (Group C) an uncoated membrane oxygenator was employed. Systemic inflammatory reactions, such as platelet activation, prostaglandin production, complement activation, and activated granulocyte released substance, were measured prior to, during, and 6 h after CPB. The number of platelets decreased after protamine administration in both groups (14.5 +/- 4.7 x 10(4)/microliters in Group H and 13.8 +/- 8.7 x 10(4)/microliters in Group C) and returned to baseline levels in Group H while it remained decreased in Group C at 6 h after CPB. The platelet factor 4 level was significantly lower in Group H (181 +/- 40 ng/ml) than in Group C (297 +/- 131 ng/ml) after protamine administration. Thromboxane-B2 (TXB2) rose during CPB in both groups; however, there were significantly different levels of TXB2 between the 2 groups at 60 min after CPB (293 +/- 258 pg/ml in Group H versus 408 +/- 120 pg/ml in Group C) and after protamine administration (259 +/- 122 pg/ml in Group H versus 709 +/- 418 pg/ml in Group C). Plasma concentrations of granulocyte elastase were significantly lower in Group H at 30, 60 and 90 min, immediately after, and post-CPB than those of Group C.(ABSTRACT TRUNCATED AT 250 WORDS)