Comparison of a Duraflo II-coated cardiopulmonary bypass circuit and a trillium-coated oxygenator during open-heart surgery

Hoel, Terje; Videm, Vibeke; Baksaas, Svein Tore; Mollnes, Tom Eirik; Brosstad, Frank; Svennevig, Jan

doi:10.1191/0267659104pf737oa

Cited by 15 publications

(6 citation statements)

References 35 publications

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“…Eynden et al [12] compared outcomes in patients undergoing CPB with either an Avecor oxygenator with Trilium or an uncoated circuit and found that the Avecor circuit decreased intra-operative blood loss during surgery without affecting overall blood transfusion requirements. Hoel et al [13] compared outcomes in patients undergoing CPB with either the Trillium or Duraflo II (heparin-bonded) circuits. They documented an earlier increase in the β-thromboglobulin concentration in the Trillium group but found no other significant differences in outcomes.…”

Section: Resultsmentioning

confidence: 99%

Is a fully heparin-bonded cardiopulmonary bypass circuit superior to a standard cardiopulmonary bypass circuit?

Mahmood¹,

Bilal²,

Zaman³

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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A best-evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is a fully heparin bonded cardiopulmonary bypass circuit superior to a standard cardiopulmonary bypass circuit?' Altogether more than 792 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated (Table 1). The studies analysed show that perfusion with heparin-coated and heparin-polymer-coated bypass does not increase the risk of adverse effects but reduces blood loss, re-operation rates, ventilation time, length of intensive care unit (ICU) and hospital stay and is also associated with improved biocompatibility, as evidenced by platelet preservation, reduced leucocyte and complement activation, and proinflammatory cytokine production. The various coated circuits have comparable biocompatibility as evaluated by a range of inflammatory markers and clinical outcomes. Three studies documented a significant decrease in post-operative blood loss (P = 0.001-0.54) and a meta-analysis found that perfusion with a heparin-bonded circuit resulted in a reduction in blood transfusion requirements (20%), ventilation time (P < 0.01), length of time in the ICU (P < 0.01) and also hospital stay (P = 0.02). Two studies found reduced levels of polymorphonuclear elastase (P < 0.018-0.001) and two trials concluded that the use of heparin-coated circuits in combination with low-dose systemic heparin (activated clotting time >250) resulted in the greatest clinical benefit and improvement in inflammation. One study documented significant platelet preservation with the use of third-generation heparin-polymer-bonded circuits (P ≤ 0.05). We conclude that despite heparin-bonded and newer third-generation heparin-polymer-bonded cardiopulmonary bypass circuits having a greater cost per person, their improved clinical outcomes and biocompatibility in patients undergoing cardiac surgery make them a preferable option to standard non-heparin-bonded circuits.

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Section: Resultsmentioning

confidence: 99%

Is a fully heparin-bonded cardiopulmonary bypass circuit superior to a standard cardiopulmonary bypass circuit?

Mahmood¹,

Bilal²,

Zaman³

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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“…This is consistent with the fact that while age is associated with a low-grade inflammatory state, 5,13,14 upregulation of the inflammatory response and microvascular blood flow tends to decline with age. [15][16][17][18][19] In addition, studies have shown that when comparing postoperative elderly patients who developed NCD versus those who did not, there was no difference in preoperative inflammatory markers between groups. 18,20 Evaluated with our current study, this may mean that although elderly patients do experience NCD, systemic inflammation may be a more direct mechanism in younger versus older patients.…”

Section: Cytokine Analysismentioning

confidence: 99%

Younger age is associated with greater early neurocognitive decline postcardiopulmonary bypass

et al. 2020

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Objective: To examine the effect of aging on postoperative neurocognitive decline (NCD) in cardiac surgery patients. Methods: Patients undergoing coronary artery bypass graft or open aortic valve replacement were administered the Repeatable Battery for the Assessment of Neuropsychological Status at preoperative, postoperative day (POD) 4, and 1 month. Blood samples were collected at preoperative, 6 hours postoperative, and POD 4. Plasma interleukin (IL)-6, tumor necrosis factor-a, and C-reactive protein (CRP) levels were quantified. Quality of life was measured with the 12-Item Short Form Health Survey. Data were analyzed using paired ratio and unpaired t tests with Welch's correction, and linear regression for cytokine levels. Results: NCD occurred in 15 patients (N ¼ 33, 45.5%). Dichotomized at age extremes (<60 years; !75 years), youngest patients had greater preoperative scores (P ¼ .02) with lower scores by POD 4 (P ¼ .03). There was no NCD in the oldest patients, and scores were not different between age groups on POD 4 (P ¼ .08). Regression at 1 month showed NCD scores again declined by age (n ¼ 15), with younger scores returning toward baseline (P ¼ .008). Regression analyses showed decline by age at 6 hours postoperative and POD 4 in plasma CRP levels (P ¼ .05 6 hours, P ¼ .02 POD 4). Dichotomizing IL-6 levels by age (<70 years, !70 years) demonstrated that levels were greater in younger versus older patients at 6 hours postoperative (P ¼ .03), but not on POD 4. Conclusions: Younger patients tend to have better cognitive scores before surgery but scores at POD 4 are similar to those of older patients, with this trend disappearing at 1 month. IL-6 and CRP upregulation is greater in younger patients, suggesting that a robust perioperative inflammatory response may be associated with reduction in neurocognitive function, and this may be greater in younger versus older patients. (JTCVS Open 2020;1:1-9) CPB upregulates IL-6 and CRP in cerebral microvasculature, leading to cognitive decline. CENTRAL MESSAGE Younger age (<60) is associated with greater perioperative NCD and inflammatory upregulation and poorer long-term QOL. This should be considered in the risks of cardiac surgery in younger patients. PERSPECTIVE Neurocognitive decline is a known risk of cardiac surgery, but its complex etiology has made it difficult to determine a definitive MOA or which populations are most at risk. Although younger patients may regain relatively greater cognition compared with older counterparts, potential for greater impact on QOL must be considered when assessing risks and timing of surgery.

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“…60 In a recently published randomized controlled trial comparing the Duraflo II totally heparin-coated CPB system with the Trillium Biopassive surface-coatedAffinity oxygenator (Medtronic, Inc., Minneapolis, MN, USA), only small differences in the inflammatory response between the two extracorporeal circulation devices were noticed. 61…”

Section: Strategies To Improve Biocompatibility Of the Extracorporealmentioning

confidence: 99%

Modulation of Systemic Inflammatory Response after Cardiac Surgery

Raja

Dreyfus

2005

Asian Cardiovasc Thorac Ann

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Cardiac surgery and cardiopulmonary bypass initiate a systemic inflammatory response largely determined by blood contact with foreign surfaces and the activation of complement. It is generally accepted that cardiopulmonary bypass initiates a whole-body inflammatory reaction. The magnitude of this inflammatory reaction varies, but the persistence of any degree of inflammation may be considered potentially harmful to the cardiac patient. The development of strategies to control the inflammatory response following cardiac surgery is currently the focus of considerable research efforts. Diverse techniques including maintenance of hemodynamic stability, minimization of exposure to cardiopulmonary bypass circuitry, and pharmacologic and immunomodulatory agents have been examined in clinical studies. This article briefly reviews the current concepts of the systemic inflammatory response following cardiac surgery, and the various therapeutic strategies being used to modulate this response.

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Comparison of a Duraflo II-coated cardiopulmonary bypass circuit and a trillium-coated oxygenator during open-heart surgery

Abstract: There were small differences in the inflammatory response between the two extracorporeal circulation devices compared in this study.

Cited by 15 publications

References 35 publications

Is a fully heparin-bonded cardiopulmonary bypass circuit superior to a standard cardiopulmonary bypass circuit?

Is a fully heparin-bonded cardiopulmonary bypass circuit superior to a standard cardiopulmonary bypass circuit?

Younger age is associated with greater early neurocognitive decline postcardiopulmonary bypass

Modulation of Systemic Inflammatory Response after Cardiac Surgery

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