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Blood-surface interactions during cardiopulmonary bypass
1Department of Cardiothoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia.
Journal of Cardiac Surgery
|May 1, 1993
Summary
Cardiopulmonary bypass (CPB) triggers a systemic inflammatory response due to blood interacting with synthetic surfaces. Controlling this blood-surface interaction is key to reducing complications during open heart surgery.
Area of Science:
- Biomedical Engineering
- Cardiovascular Surgery
- Hematology
Background:
- The heart-lung machine (HLM) used in cardiopulmonary bypass (CPB) causes a systemic inflammatory response.
- Blood contact with synthetic surfaces activates plasma proteins and blood cells, releasing vasoactive substances.
- This response impairs organ function and increases risks of bleeding and thrombosis.
Purpose of the Study:
- To explain the mechanisms of the inflammatory response during CPB.
- To review current strategies for controlling CPB-associated morbidity.
- To highlight the importance of managing blood-surface interactions.
Main Methods:
- Review of literature on blood-surface interactions during CPB.
- Analysis of plasma protein system activation (coagulation, complement, fibrinolysis).
- Examination of cellular responses (platelets, neutrophils).
Main Results:
- CPB activates factor XII, complement, and platelets, leading to inflammation and altered vascular tone.
- Endothelial cells produce tissue plasminogen activator, generating plasmin and affecting fibrinolysis.
- Blood becomes a complex mixture of enzymes and chemicals, increasing capillary permeability and impairing organ function.
Conclusions:
- Reversible inhibitors of specific reactions show promise in controlling CPB morbidity.
- Platelet inhibitors (prostanoids, disintegrins) and serine protease inhibitors are under investigation.
- Managing blood-surface interactions is crucial for mitigating adverse outcomes in open heart surgery.