Effects of Duraflo II Heparin‐Coated Cardiopulmonary Bypass Circuits on the Coagulation System, Endothelial Damage, and Cytokine Release in Patients with Cardiac Operation Employing Aprotinin and Steroids

Abstract

The effects of Duraflo II heparin coated cardiopulmonary bypass circuits, low-dose aprotinin, and steroids on the coagulation system, endothelial damage, and cytokine release were evaluated by comparing those treated with low-dose aprotinin and steroids. Twenty-four adult patients undergoing coronary artery bypass grafting, aortic valve replacement, or valve repair surgery were randomly assigned to 2 groups: either heparin-coated (Duraflo group, n = 12) or noncoated equipment (noncoated group, n = 12) groups. In the Duraflo group, the cardiopulmonary reservoir was also coated with heparin. There were no significant differences in age at the time of operation, aortic cross-clamp time, cardiopulmonary bypass time, and rectal temperature during cardiopulmonary bypass. Standard systemic heparinization was performed. Methylpredonisolone and low-dose aprotinin were given in both groups of patients. Serum XIIa factor, TAT, and IL-6 were significantly higher in the control group than in the Duraflo group during cardiopulmonary bypass (p < 0.01). Serum IL-8 was significantly higher in the control group than in the Duraflo group at 24 h after cardiopulmonary bypass (p < 0.05). No significant difference was found in serum thrombomodulin and TNF-alpha; both were within normal during the study period. These results indicate that the use of Duraflo II heparin coated equipment and a heparin-coated cardiopulmonary reservoir suppressed excess coagulation and inflammatory reaction induced by cardiopulmonary bypass.

In vitro evaluation of platelet reactivity toward annuloplasty devices treated with heparin coating: Studies under flow conditions

“…None of the cases showed statistical differences in levels of F1 + 2 in plasma. These results agree with those of other studies that indicated that the use of heparin‐coated equipment suppressed excessive coagulation and inflammatory reactions induced by cardiopulmonary bypass 20, 42. The presence of apoptotic cells interacting with the material seems to be related to the extended time circulating in the extracorporeal circuit during the surgical procedure.…”

Patient blood management during cardiac surgery: Do we have enough evidence for clinical practice?

“…Surface treatment of circuit and oxygenator includes any chemical treatment that aims to increase the biocompatibility of CPB materials. Much evidence exists that surface treatments of CPB materials decrease the inflammatory response to CPB, [146][147][148][149][150][151] limit hemostatic activation, 147,152 and preserve platelet function, 148,153,154 even if thrombin generation does not appear to be directly affected by these treatments. 155 It is therefore reasonable to hypothesize that surface treatments would decrease allogeneic blood product transfusion rate through a combination of these effects.…”

Adsorption of Inflammatory Cytokines Using a Heparin‐Coated Extracorporeal Circuit

“…Subsequently, the column was flushed 6 times with 1.5 ml of FBS containing the indicated heparin concentration. Fractions (1–7; 1.5 ml each) were then collected and analyzed for the contents of TNF‐α or IL‐6, using commercially available human TNF‐α and IL‐6 immunoassay kits (Endogen Co, Woburn, MA, U.S.A.), respectively.…”

“…The technique to immobilize heparin onto the surfaces generally falls into 2 categories, namely, ionically and covalently bonded heparin (4). Several clinical studies have demonstrated that heparin‐coated extracorporeal circuits (5–7) or heparin‐bonded oxygenators (8) reduce the neutrophil and complement activation with an improved clinical outcome and reduced cytokine release. It is known that heparin binds a large number of growth factors and cytokines, including fibroblast growth factors, hepatocyte growth factor, platelet‐derived growth factors, vascular endothelial growth factors, TNF‐α, IL‐1, IL‐2, IL‐6, and IL‐8 (9–14).…”