Clinical study of biocompatibility between open and closed heparin-coated cardiopulmonary bypass circuits

Abstract

The objective of this study was to investigate the difference between the closed circuit system and the open circuit system in clinical heparin-coated cardiopulmonary bypass (CPB) circuits with a centrifugal pump. We evaluated the coagulation, fibrinolysis, and inflammatory response in valvular heart surgery. Nineteen patients were assigned at random to a group for the closed circuit system or the open circuit system. This is the first report on the effect of a closed circuit in valvular surgery. We measured the platelet count, white blood cell count, plasma fibrinogen concentration, thrombin-antithrombin III complex, plasmin-Alpha2 plasmin inhibitor complex, D-dimer, interleukin-6, polymorphic neutrophil-elastase, and the plasma free hemoglobin. Blood samples were collected before the start of perfusion, 15 and 60 min after the start of perfusion, 60 min after the administration of protamine, and 1 day after the operation. During the perfusion, coagulation, fibrinolysis, and inflammatory responses were activated; however, no significant differences between the two groups were noted. In this clinical investigation with suction and the cell saving system, the closed circuit was not found to be superior to the open circuit with regard to biocompatibility.

Microbubble Generation and Transmission of Medtronic’s Affinity Hardshell Venous Reservoir and Collapsible Venous Reservoir Bag: An In-Vitro Comparison

“…Also, any turbulence associated waterfall effect at low volumes induces microbubble formation and increases blood shear stresses. Indeed, evidence of increased blood damage with associated bleeding and need for red cell transfusions have been demonstrated with HSVRs in clinical studies comparing HSVRs with SSVRs (25)(26)(27).…”

Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors

“…However, individual studies found conflicting results. The studies conducted by Tanaka et al and Gunaydin et al did not find any significant difference between open circuits (combined reservoir) and closed circuits (separated reservoir) [25,27]. Meanwhile, Pierangelli et al and Nasso et al found a significant difference between the two groups [26,28].…”

“…Interventions varied regarding components of CPB such as types of pumps [6][7][8][9][10][11][12][13][14][15][16][17][18], types of oxygenators [19][20][21][22], types of cannulas [23], and types of suctions [24]; circuit management, such as separated reservoir [25][26][27][28], coating [29][30][31][32][33][34][35][36][37], venous drainage [38][39][40]; techniques, such as pulsatility [3,[41][42][43][44], retransfusion [45,46], the use of cell saver [47][48][49], cardioplegia [50], priming [51], medications [4,[52]…”

Cardiotomy suction, but not open venous reservoirs, activates coagulofibrinolysis in coronary artery surgery

“…10 Even with standard heparinization and heparin-coated circuits, thrombin generation is inevitable in cardiac surgeries using CPB. [9][10][11] Cardiotomy suction and open venous reservoirs have been demonstrated to contribute to the activation of the coagulofibrinolysis and inflammation systems [12][13][14][15][16] ; however, the contribution of each has not yet been comparatively examined. 7 In the use of closed and miniaturized circuits, highly sophisticated miniaturization can also affect the coagulofibrinolysis and inflammation systems owing to the prevention of hemodilution and a reduction of the blood-circuit contact area.…”