A comparative evaluation of the effect of pump type and heparin-coated surfaces on platelets during cardiopulmonary bypass
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M Misoph1, J Babin-Ebell, S Schwender
1Department of Cardiothoracic Surgery, University Hospital, Würzburg, Germany.
Insights
Different cardiopulmonary bypass (CPB) systems did not affect platelet count. GMP-140 expression on platelets changed during and after CPB, with no clear advantage for centrifugal or heparin-coated circuits.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Biomedical Engineering
Background:
- Cardiopulmonary bypass (CPB) can cause hemostatic disorders, primarily due to impaired platelet function.
- Understanding the impact of different CPB circuits on platelet function is crucial for patient safety.
Purpose of the Study:
- To compare the effects of roller pump, centrifugal pump, and heparin-coated centrifugal pump CPB circuits on platelet count and GMP-140 expression.
- To evaluate potential differences in platelet activation and function across various CPB systems.
Main Methods:
- Prospective study involving 61 coronary artery bypass grafting patients.
- Random assignment to three CPB circuit groups: roller pump, centrifugal pump, and heparin-coated centrifugal pump.
- Analysis of platelet count and GMP-140 expression pre-, during, and post-CPB.
Main Results:
- No significant effect of any CPB system on platelet count was observed.
- GMP-140 expression showed a transient increase during CPB, followed by a significant decrease postoperatively.
- Minor differences in GMP-140 expression were noted between centrifugal pump groups post-protamine administration.
Conclusions:
- The tested CPB systems did not demonstrate a clear advantage in preserving platelet function.
- The observed effects on platelet function may be influenced by the specific operative procedure and overall patient management.
- Further research is needed to elucidate the optimal CPB circuit strategy for minimizing hemostatic complications.
Abstract:
Cardiopulmonary bypass (CPB) is associated with hemostatic disorders, mainly due to platelet function defects. In the present prospective study, platelet count and GMP-140 expression on platelets were investigated to comparatively evaluate the impact of different CPB-circuit systems on platelets. The study included 61 patients undergoing coronary artery bypass grafting, randomly assigned to 3 groups. In group A a roller pump, in group B a centrifugal pump, and in group C a centrifugal pump with a Carmeda heparin-coated CPB circuit was applied. Platelet count and GMP-140 expression were analysed pre, during, and following CPB. None of the tested CPB systems did affect platelet count. The percentage of GMP-140-positive platelets increased slightly early during CPB, whereas it decreased significantly postoperatively; group differences were observed between B and C after protamin administration. An advantage of the use of centrifugal pumps and heparin-coated circuits could not be proven with the present set-up. The results suggest that the benefit of the tested systems might depend on the operative procedure and management.
