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Biocompatibility of heparin-coated circuits used in cardiopulmonary bypass
M Pekna1, J Borowiec, M K Fagerhol
1Department of Clinical Immunology and Transfusion Medicine, University Hospital, Uppsala, Sweden.
Insights
Heparin-coated cardiopulmonary bypass (CPB) circuits reduce leukocyte activation during cardiac surgery. This surface modification enhances CPB biocompatibility by lowering inflammatory markers.
Area of Science:
- Biomedical Engineering
- Cardiovascular Surgery
- Immunology
Background:
- Cardiopulmonary bypass (CPB) circuits can activate the complement system and blood leukocytes.
- Inflammatory responses during CPB can lead to adverse patient outcomes.
Purpose of the Study:
- To investigate the combined effect of heparin-coated CPB circuits and reduced systemic heparin dose on complement system and leukocyte activation.
- To assess the impact of heparin surface modification on CPB biocompatibility.
Main Methods:
- 19 patients undergoing coronary bypass surgery were randomly allocated to two groups.
- One group (n=10) used heparin-coated CPB circuits with a 50% reduced heparin dose (HC group).
- The control group (n=9) used standard CPB circuits with a standard heparin dose (C group).
- Levels of neutrophil-derived myeloperoxidase, lactoferrin, calprotectin, C3a, and terminal complement complexes were measured during CPB.
Main Results:
- Significant increases in myeloperoxidase, lactoferrin, and calprotectin were observed in both groups during CPB.
- Total accumulated levels of these neutrophil markers were significantly lower in the heparin-coated (HC) group compared to the control (C) group (p < 0.05).
- Complement activation, assessed by C3a and terminal complement complexes, was similar between the HC and C groups.
Conclusions:
- Surface modification of CPB circuits with heparin enhances biocompatibility.
- Heparin-coated CPB circuits, combined with reduced systemic heparin, effectively lower leukocyte activation during cardiac surgery.
- This approach may mitigate inflammatory complications associated with cardiopulmonary bypass.
Abstract:
The combined effect of heparin coating of cardiopulmonary bypass (CPB) circuits and reduced dose of systemic heparin on activation of the complement system and blood leukocytes was investigated in 19 patients undergoing coronary bypass surgery and randomly allocated to two groups. A heparin-coated CPB circuit together with a 50% reduction of the standard heparin dose were used for ten patients (HC group), and a standard CPB circuit with a standard heparin dose (300 IU/kg) for nine (C group). Significant rise in the levels of neutrophil-derived myeloperoxidase, lactoferrin and calprotectin were observed during CPB in both groups, but the total accumulated levels were significantly lower in the HC than in the C group (p < 0.05). Complement activation, assessed from levels of C3a and terminal complement complexes was similar in both groups. The lower levels of myeloperoxidase, lactoferrin and calprotectin during CPB in the HC group indicate that surface modification with end-point attached heparin enhances the biocompatibility of CPB.