A closed perfusion system with heparin coating and centrifugal pump improves cardiopulmonary bypass biocompatibility in elderly patients.
ABSTRACT Cardiopulmonary bypass induces a systemic inflammatory and hemostatic activation, which may contribute to postoperative complications. Our aim was to compare the inflammatory response, coagulation, and fibrinolytic activation between two different perfusion systems: one theoretically more biocompatible with a closed-circuit, complete heparin coating, and a centrifugal pump, and one conventional system with uncoated circuit, roller pump, and a hard-shell venous reservoir.
Forty-one elderly patients (mean age, 73 +/- 1 years, 66% men) undergoing coronary artery bypass grafting or aortic valve replacement were included in a prospective, randomized study. Plasma concentrations of complement factors (C3a, C4d, Bb, and sC5b-9), proinflammatory cytokines (tumor necrosis factor-alpha, interleukin-6, and interleukin-8), granulocyte degradation products (polymorphonuclear elastase), and markers of coagulation (thrombin-antithrombin) and fibrinolysis (D-dimer, tissue plasminogen activator antigen and tissue plasminogen activator-plasminogen activator inhibitor-1 complex) were measured preoperatively, at bypass during rewarming (35 degrees C), 60 minutes after bypass, and on day 1 after surgery.
The mean concentrations of C3a (-39%; p = 0.008), Bb (-38%; p < 0.001), sC5b-9 (-70%; p < 0.001), interleukin-8 (-60%; p = 0.009), polymorphonuclear-elastase (-55%; p < 0.003), and tissue plasminogen activator antigen (-51%; p = 0.012) were all significantly lower in the biocompatible group during rewarming. Sixty minutes after bypass, the mean concentrations of sC5b-9 (-39%; p = 0.006) and polymorphonuclear-elastase (-55%; p < 0.001) were lower in the biocompatible group.
The results suggest that a closed perfusion system with a heparin-coated circuit and a centrifugal pump may improve cardiopulmonary bypass biocompatibility in elderly cardiac surgery patients in comparison with a conventional system.
Article: Efficacy of a heparin-coated closed circuit for intractable bleeding in adult cardiac surgery.[show abstract] [hide abstract]
ABSTRACT: Hemostatic procedures and control of blood pressure concomitant with rapid transfusion of blood products aimed at recovery of coagulability are necessary for intractable bleeding during cardiac surgery. However, when the bleeding is massive and hemostasis is prolonged for several hours, operative maneuvers such as manual compression of the heart can affect hemodynamics, decrease cardiac output, and elevate atrial and venous pressure, with consequent hepatic, renal, and pulmonary dysfunction over time. Herein we present three cases of potentially fatal bleeding during open-heart surgery, in which we used a heparin-coated closed circuit for circulatory support after standard cardiopulmonary bypass. We achieved stable hemodynamics following surgical hemostatic maneuvers and avoided the postoperative multiple organ failure by using a cardiopulmonary support system.Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 04/2010; 16(2):131-3.