Influence of Duraflo II heparin-treated extracorporeal circuits on the systemic inflammatory response in patients having coronary bypass

Abstract

Cardiopulmonary bypass generates a systemic inflammatory response, including the activation of leukocytes, contributing to postoperative morbidity. To evaluate whether the use of heparin-treated extracorporeal circuits could reduce the inflammatory reaction in patients undergoing cardiopulmonary bypass, we conducted a prospective clinical study on 14 patients having coronary artery bypass in whom perfusion was done randomly with either Duraflo II heparin-treated circuits or with nontreated circuits. In both groups systemic heparinization was performed before cardiopulmonary bypass. The use of heparin-treated circuits resulted in a reduction of systemic inflammatory activation during cardiopulmonary bypass. This was reflected by lower plasma levels of soluble tumor necrosis factor receptors (p< 0.05) and of interleukin-6 and interleukin-8 (p < 0.05), manifest after release of the aortic crossclamp. Furthermore, 6 and 12 hours after aortic crossclamp release significantly lower levels of the soluble E-selectin (p < 0.05) were observed in the Duraflo II group. In patients in whom noncoated circuits were used, a significant decrease in circulating soluble intercellular adhesion molecule 1 (p < 0.05) was found early during bypass. All these observations suggest that the use of a heparin-treated extracorporeal circuit reduces the systemic inflammatory activation and may after the leukocyte-endothelium interaction.

Biocompatibility of Heparin‐Coated Extracorporeal Bypass Circuits: New Heparin Bonded Bioline System

“…With various ionic preparations or by covalent binding to the surface, heparin can be attached to polymers. Although heparincoating technologies were originally employed to increase antithrombogenicity, other positive impacts for biocompatibility were aggressively reported, such as decreased neutrophil and complement activation, and inhibited proinflammatory cytokine production (1)(2)(3)(4). Currently, a new heparin bonding system, the Jostra Bioline coating system, has become clinically available.…”

Thrombin generation during cardiopulmonary bypass: the possible role of retransfusion of blood aspirated from the surgical field

“…Recent improvements in biocompatibility of the extracorporeal circuit, such as heparin coatings, have resulted in considerably less blood activation [9-13]. Despite these improvements, however, we and also other investigators reported no reduction in thrombin generation in patients undergoing CPB with the use of a heparin-coated extracorporeal circuit [14-17], whereas others have found evidence of some possible benefit of these surfaces on the coagulation cascade [18].…”

APT070 inhibits complement activation during in vitro cardiopulmonary bypass

“…Interestingly this is not seen, but there would appear to be inconsistencies in previously published work. In some studies cytokine levels have been undetectable [24], but other investigators have reported a rise in cytokines at the onset of in vivo CPB or when the crossclamp is removed [25]. It maybe that IL-8 and TNF are degraded at a rate that at least matches production, or that a larger sample size would show a significant difference between the groups.…”