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Jan L Svennevig - One of the best experts on this subject based on the ideXlab platform.

  • heparin coated Cardiopulmonary Bypass Equipment ii mechanisms for reduced complement activation in vivo
    The Journal of Thoracic and Cardiovascular Surgery, 1999
    Co-Authors: Vibeke Videm, Tom Eirik Mollnes, Kare Bergh, Erik Fosse, Brit Mohr, Torarne Hagve, A O Aasen, Jan L Svennevig
    Abstract:

    Abstract Objective: Our objective was to study mechanisms for reduced complement activation by heparin coating of Cardiopulmonary Bypass Equipment in clinical heart surgery. Methods: Adults undergoing elective coronary artery Bypass grafting were randomized to Cardiopulmonary Bypass with Duraflo II heparin-coated (n = 15) or uncoated (n = 14) sets (Duraflo coating surface; Baxter International, Inc, Deerfield, Ill). Blood samples were analyzed with the use of enzyme immunoassays for C1rs-C1 inhibitor complexes and the activation products Bb, C4bc, C3bc, C5a-desArg, and the terminal complement complex. Data were compared by repeated-measures analysis of variance. Results : C1 was activated during Bypass, and increases in C1rs-C1 inhibitor complexes were larger with heparin coating ( P = .03). C4bc increased after administration of protamine, without intergroup differences ( P = .69). Bb ( P = .22) and C5a-desArg ( P = .13) tended to increase less with heparin coating. Formation of C3bc ( P = .03) and the terminal complement complex ( P R = 0.6, P R P > .8). Conclusions : C1 activation during Bypass was increased by heparin coating, but further classical pathway activation was held in check until administration of protamine. Heparin coating significantly inhibited C3bc and terminal complement complex formation. Terminal complement complex concentrations were related to alternative pathway activation and may be useful for evaluation of differences in Bypass circuitry. Increases and intergroup differences in terminal complement complex concentrations were much larger than those in C5a-desArg. (J Thorac Cardiovasc Surg 1999;117:803-9)

  • heparin coated Cardiopulmonary Bypass Equipment i biocompatibility markers and development of complications in a high risk population
    The Journal of Thoracic and Cardiovascular Surgery, 1999
    Co-Authors: Vibeke Videm, Tom Eirik Mollnes, Kare Bergh, Erik Fosse, Brit Mohr, Torarne Hagve, A O Aasen, Jan L Svennevig
    Abstract:

    Abstract Objectives: 1. To study possible clinical benefits of heparin-coated Cardiopulmonary Bypass in patients with a broad range of preoperative risk factors. 2. To evaluate the correlation between the terminal complement complex and clinical outcome. 3. To identify clinical predictors of complement activation and correlates of granulocyte activation during cardiac surgery. Methods : Blood samples from adults undergoing elective cardiac surgery with Duraflo II heparin-coated (n = 81) or uncoated (n = 75) Cardiopulmonary Bypass sets (Duraflo coating surface; Baxter International, Inc, Deerfield, Ill) were analyzed for activation of complement (C3 activation products, terminal complement complex), granulocytes (myeloperoxidase, lactoferrin), and platelets (β-thromboglobulin) by enzyme immunoassays. Preoperative risk was assessed by means of the "Higgins' score." Complications (cardiac, renal, pulmonary, gastrointestinal, and central nervous system dysfunction, infections, death) were registered prospectively. Data were analyzed by analysis of variance, logistic regression, and linear regression. Results and conclusions : Sixty-seven percent of the patients had predefined risk factors. Complications developed in 53 patients (34%), equivalently with and without heparin-coated Bypass sets ( P = .44-.82), despite a significant reduction in complement and granulocyte activation by heparin coating. No clear-cut relationship between the terminal complement complex and outcome was found, even if it was significant in the models for renal and central nervous system dysfunction and infections ( P = .006). The Higgins' score was significantly related to complement activation ( P P ≤ .01) and platelet activation ( P P = .02), duration of Cardiopulmonary Bypass ( P P

Vibeke Videm - One of the best experts on this subject based on the ideXlab platform.

  • heparin coated Cardiopulmonary Bypass Equipment ii mechanisms for reduced complement activation in vivo
    The Journal of Thoracic and Cardiovascular Surgery, 1999
    Co-Authors: Vibeke Videm, Tom Eirik Mollnes, Kare Bergh, Erik Fosse, Brit Mohr, Torarne Hagve, A O Aasen, Jan L Svennevig
    Abstract:

    Abstract Objective: Our objective was to study mechanisms for reduced complement activation by heparin coating of Cardiopulmonary Bypass Equipment in clinical heart surgery. Methods: Adults undergoing elective coronary artery Bypass grafting were randomized to Cardiopulmonary Bypass with Duraflo II heparin-coated (n = 15) or uncoated (n = 14) sets (Duraflo coating surface; Baxter International, Inc, Deerfield, Ill). Blood samples were analyzed with the use of enzyme immunoassays for C1rs-C1 inhibitor complexes and the activation products Bb, C4bc, C3bc, C5a-desArg, and the terminal complement complex. Data were compared by repeated-measures analysis of variance. Results : C1 was activated during Bypass, and increases in C1rs-C1 inhibitor complexes were larger with heparin coating ( P = .03). C4bc increased after administration of protamine, without intergroup differences ( P = .69). Bb ( P = .22) and C5a-desArg ( P = .13) tended to increase less with heparin coating. Formation of C3bc ( P = .03) and the terminal complement complex ( P R = 0.6, P R P > .8). Conclusions : C1 activation during Bypass was increased by heparin coating, but further classical pathway activation was held in check until administration of protamine. Heparin coating significantly inhibited C3bc and terminal complement complex formation. Terminal complement complex concentrations were related to alternative pathway activation and may be useful for evaluation of differences in Bypass circuitry. Increases and intergroup differences in terminal complement complex concentrations were much larger than those in C5a-desArg. (J Thorac Cardiovasc Surg 1999;117:803-9)

  • heparin coated Cardiopulmonary Bypass Equipment i biocompatibility markers and development of complications in a high risk population
    The Journal of Thoracic and Cardiovascular Surgery, 1999
    Co-Authors: Vibeke Videm, Tom Eirik Mollnes, Kare Bergh, Erik Fosse, Brit Mohr, Torarne Hagve, A O Aasen, Jan L Svennevig
    Abstract:

    Abstract Objectives: 1. To study possible clinical benefits of heparin-coated Cardiopulmonary Bypass in patients with a broad range of preoperative risk factors. 2. To evaluate the correlation between the terminal complement complex and clinical outcome. 3. To identify clinical predictors of complement activation and correlates of granulocyte activation during cardiac surgery. Methods : Blood samples from adults undergoing elective cardiac surgery with Duraflo II heparin-coated (n = 81) or uncoated (n = 75) Cardiopulmonary Bypass sets (Duraflo coating surface; Baxter International, Inc, Deerfield, Ill) were analyzed for activation of complement (C3 activation products, terminal complement complex), granulocytes (myeloperoxidase, lactoferrin), and platelets (β-thromboglobulin) by enzyme immunoassays. Preoperative risk was assessed by means of the "Higgins' score." Complications (cardiac, renal, pulmonary, gastrointestinal, and central nervous system dysfunction, infections, death) were registered prospectively. Data were analyzed by analysis of variance, logistic regression, and linear regression. Results and conclusions : Sixty-seven percent of the patients had predefined risk factors. Complications developed in 53 patients (34%), equivalently with and without heparin-coated Bypass sets ( P = .44-.82), despite a significant reduction in complement and granulocyte activation by heparin coating. No clear-cut relationship between the terminal complement complex and outcome was found, even if it was significant in the models for renal and central nervous system dysfunction and infections ( P = .006). The Higgins' score was significantly related to complement activation ( P P ≤ .01) and platelet activation ( P P = .02), duration of Cardiopulmonary Bypass ( P P

Turina Mi - One of the best experts on this subject based on the ideXlab platform.

  • Low-dose heparin versus full-dose heparin with high-dose aprotinin during Cardiopulmonary Bypass. A preliminary report.
    Texas Heart Institute Journal, 1993
    Co-Authors: L. K. Von Segesser, E. Garcia, Turina Mi
    Abstract:

    Perfusion during Cardiopulmonary Bypass with low-dose heparin (activated clotting time, > 180 sec) versus full-dose heparin (activated clotting time, > 480 sec) combined with high-dose aprotinin was evaluated prospectively. Fifteen patients undergoing elective myocardial revascularization were randomly assigned to 1 of 2 groups. No significant differences between the groups were found for age, sex, body surface area, preoperative hematocrit level, duration of Cardiopulmonary Bypass, aortic cross-clamp time, mean number of Bypasses per patient, or mean number of arterial grafts per patient. In all patients, heparin-coated Cardiopulmonary Bypass Equipment was used, including heparinized hollow-fiber membrane oxygenators and tubing sets. In each group, protamine sulfate was given equivalent to the heparin loading dose; additional doses were administered according to the ACT. The mean total dosage of heparin was 9.5 +/- 1.4 x 10(3) IU for the group given low systemic heparinization (Group 1) compared with 34.6 +/- 3.4 x 10(3) IU for the group given full systemic heparinization in combination with high-dose aprotinin (Group 2) (p < 0.0001). The mean amount of aprotinin administered in Group 2 was 5.6 +/- 0.3 x 10(6) KIU; aprotinin was not used in Group 1. The mean protamine dosage necessary in Group 1, 7.0 +/- 0.9 x 10(3) IU, was significantly less than the 22.9 +/- 3.2 x 10(3) IU needed in Group 2 (p < 0.0001). In Group 1, shed blood recovery was achieved by a red-cell spinning device; in Group 2, cardiotomy suction was used. The total chest tube drainage (i.e., postoperative blood loss) per patient in Group 1 totaled 432 +/- 162 mL/m2; in Group 2, it was 311 +/- 111 mL/m2 (difference not significant). Transfusion requirements comprised a mean volume of 143 +/- 165 mL/m2 concentrated homologous red blood cells per patient in Group 1 and 416 +/- 128 mL/m2 in Group 2 (p < 0.01). Heparin-coated perfusion Equipment allowed a significantly lower dosage of systemic heparin and protamine in Group 1 than that in Group 2, and a lower dosage in Group 2 than that in previous studies. Postoperative blood loss appeared to be similar between groups. The combination of heparin-coated perfusion Equipment with low systemic heparinization and a red-cell spinning device provides promising results.

  • Clinical application of heparin-coated perfusion Equipment with special emphasis on patients refusing homologous transfusions
    Perfusion, 1991
    Co-Authors: L. K. Von Segesser, Branko M. Weiss, E. Garcia, Turina Mi
    Abstract:

    Clinical application of heparin-coated Cardiopulmonary Bypass Equipment during perfusion with low systemic heparinization is reported with special emphasis on patients refusing any transfusion of homologous blood or blood products. Using the described technique, coronary artery revascularization was successfully performed in three Jehovah's witnesses. During perfusion, the activated clotting time (ACT) was maintained above 180 seconds. PreBypass haematocrit was 38±3% and dropped to 22±2% during Cardiopulmonary Bypass in complete haemodilution. However, the haematocrit was 28±1 % at 24 hours after Cardiopulmonary Bypass and 32±1 % after seven days. Hence, Cardiopulmonary Bypass with low systemic heparinization may further reduce Bypass induced morbidity and improve the final outcome in selected patients.

  • Experimental evaluation of heparin-coated Cardiopulmonary Bypass Equipment with low systemic heparinization and high-dose aprotinin.
    Thoracic and Cardiovascular Surgeon, 1991
    Co-Authors: Von Segesser Lk, Branko M. Weiss, Miralem Pasic, Boris Leskosek, Von Felten A, Pei P, Turina Mi
    Abstract:

    Cardiopulmonary Bypass (n = 8 calves) with heparin-coated perfusion Equipment, low-dose systemic heparinization (activated clotting time: ACT greater than 180 s) and high-dose aprotinin administration was evaluated in comparison to standard perfusion Equipment with full-dose systemic heparinization (ACT greater than 480). All animals were perfused for 6 hours and similar values were observed for blood gases and mixed venous oxygen saturation in both groups. The heparin doses given in the study group before and during the 6 hours of perfusion totalized 14660 +/- 2553 IU as compared to 60833 +/- 5137 IU for the control group. No protamin was given in the study group whereas an equivalent of 27000 +/- 5805 IU was necessary to reverse heparin in the control group. There was no difference for preBypass hematocrit versus postBypass hematocrit in the two groups. PreBypass plasma hemoglobine was 8.4 +/- 2.1 mumol/L in the study group versus 10.0 +/- 3.8 mumol/L in the control group. After mixing with the priming volume, plasma hemoglobine was 8.6 +/- 2.5 mumol/L in the study group versus 6.7 +/- 1.6 mumol/L in the control group. The highest value was observed in the study group after 2 hours of perfusion (8.2 +/- 2.1 mumol/L) versus 5 hours of perfusion in the control group (7.4 +/- 3.6 mumol/L). PreBypass LDH levels of 1610 +/- 150 IU in the study group versus 1740 +/- 210 IU in the control group moved to 1870 +/- 200 IU in the study group at 24 hours after perfusion versus 2650 +/- 400 IU in the control group at 24 hours and decreased thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)

  • Reduced blood loss and transfusion requirements with low systemic heparinization: preliminary clinical results in coronary artery revascularization
    European Journal of Cardio-Thoracic Surgery, 1990
    Co-Authors: Von Segesser Lk, Branko M. Weiss, E. Garcia, Gallino A, Turina Mi
    Abstract:

    In coronary artery revascularization, low systemic heparinization was compared to full systemic heparinization during perfusion with heparin surface-coated Cardiopulmonary Bypass Equipment. Twelve patients were randomly assigned to two groups and perfused with low [activated clotting time (ACT) greater than 180 s] or full (ACT greater than 480 s) systemic heparinization. A standard battery of blood samples was taken before the procedure, after heparinization, and at regular intervals during and after Cardiopulmonary Bypass. No differences were seen between the two groups in regard to age, body surface area, preoperative hematocrit, duration of Bypass, Bypass hypothermia, cross-clamp time, and number of Bypasses per patient. However, there were more internal thoracic artery (ITA) grafts in the group with low systemic heparinization (1.5 +/- 0.8 ITA grafts per patient versus 0.8 +/- 0.4 ITA grafts per patient with full heparinization; p less than 0.05). The oxygenator gradient at the end of perfusion (before weaning) was 107 +/- 40 mmHg for low versus 110 +/- 10 mmHg for full heparinization (difference not significant). The total amount of heparin used was 7200 +/- 1030 IU for low versus 51400 +/- 9700 IU for full (p less than 0.05). Postoperative hematocrit was 35.0 +/- 2.0% for low versus 24.7 +/- 2.7% for full (p less than 0.05). Total chest tube drainage was 428 +/- 153 ml/m2 for low versus 935 +/- 414 ml/m2 for full (p less than 0.05). Homologous transfusions of blood products were necessary in 3/6 patients for low versus 6/6 patients for full (p less than 0.10).(ABSTRACT TRUNCATED AT 250 WORDS)

Tom Eirik Mollnes - One of the best experts on this subject based on the ideXlab platform.

  • heparin coated Cardiopulmonary Bypass Equipment ii mechanisms for reduced complement activation in vivo
    The Journal of Thoracic and Cardiovascular Surgery, 1999
    Co-Authors: Vibeke Videm, Tom Eirik Mollnes, Kare Bergh, Erik Fosse, Brit Mohr, Torarne Hagve, A O Aasen, Jan L Svennevig
    Abstract:

    Abstract Objective: Our objective was to study mechanisms for reduced complement activation by heparin coating of Cardiopulmonary Bypass Equipment in clinical heart surgery. Methods: Adults undergoing elective coronary artery Bypass grafting were randomized to Cardiopulmonary Bypass with Duraflo II heparin-coated (n = 15) or uncoated (n = 14) sets (Duraflo coating surface; Baxter International, Inc, Deerfield, Ill). Blood samples were analyzed with the use of enzyme immunoassays for C1rs-C1 inhibitor complexes and the activation products Bb, C4bc, C3bc, C5a-desArg, and the terminal complement complex. Data were compared by repeated-measures analysis of variance. Results : C1 was activated during Bypass, and increases in C1rs-C1 inhibitor complexes were larger with heparin coating ( P = .03). C4bc increased after administration of protamine, without intergroup differences ( P = .69). Bb ( P = .22) and C5a-desArg ( P = .13) tended to increase less with heparin coating. Formation of C3bc ( P = .03) and the terminal complement complex ( P R = 0.6, P R P > .8). Conclusions : C1 activation during Bypass was increased by heparin coating, but further classical pathway activation was held in check until administration of protamine. Heparin coating significantly inhibited C3bc and terminal complement complex formation. Terminal complement complex concentrations were related to alternative pathway activation and may be useful for evaluation of differences in Bypass circuitry. Increases and intergroup differences in terminal complement complex concentrations were much larger than those in C5a-desArg. (J Thorac Cardiovasc Surg 1999;117:803-9)

  • heparin coated Cardiopulmonary Bypass Equipment i biocompatibility markers and development of complications in a high risk population
    The Journal of Thoracic and Cardiovascular Surgery, 1999
    Co-Authors: Vibeke Videm, Tom Eirik Mollnes, Kare Bergh, Erik Fosse, Brit Mohr, Torarne Hagve, A O Aasen, Jan L Svennevig
    Abstract:

    Abstract Objectives: 1. To study possible clinical benefits of heparin-coated Cardiopulmonary Bypass in patients with a broad range of preoperative risk factors. 2. To evaluate the correlation between the terminal complement complex and clinical outcome. 3. To identify clinical predictors of complement activation and correlates of granulocyte activation during cardiac surgery. Methods : Blood samples from adults undergoing elective cardiac surgery with Duraflo II heparin-coated (n = 81) or uncoated (n = 75) Cardiopulmonary Bypass sets (Duraflo coating surface; Baxter International, Inc, Deerfield, Ill) were analyzed for activation of complement (C3 activation products, terminal complement complex), granulocytes (myeloperoxidase, lactoferrin), and platelets (β-thromboglobulin) by enzyme immunoassays. Preoperative risk was assessed by means of the "Higgins' score." Complications (cardiac, renal, pulmonary, gastrointestinal, and central nervous system dysfunction, infections, death) were registered prospectively. Data were analyzed by analysis of variance, logistic regression, and linear regression. Results and conclusions : Sixty-seven percent of the patients had predefined risk factors. Complications developed in 53 patients (34%), equivalently with and without heparin-coated Bypass sets ( P = .44-.82), despite a significant reduction in complement and granulocyte activation by heparin coating. No clear-cut relationship between the terminal complement complex and outcome was found, even if it was significant in the models for renal and central nervous system dysfunction and infections ( P = .006). The Higgins' score was significantly related to complement activation ( P P ≤ .01) and platelet activation ( P P = .02), duration of Cardiopulmonary Bypass ( P P

  • Attenuation of changes in leukocyte surface markers and complement activation with heparin-coated Cardiopulmonary Bypass.
    The Annals of Thoracic Surgery, 1997
    Co-Authors: Oddvar Moen, Erik Fosse, Per Venge, Kolbjørn Høgåsen, Einar Dregelid, Vibeke Brockmeier, Morten Harboe, Tom Eirik Mollnes
    Abstract:

    Abstract Background . The inflammatory response induced by Cardiopulmonary Bypass can result in severe organ dysfunction in some patients. This postperfusion response is caused mainly by contact between blood and the foreign surface of the Cardiopulmonary Bypass Equipment and includes adhesion of leukocytes to vascular endothelium, which precedes a series of events that mediate inflammatory damage to tissues. Methods . Low-risk patients accepted for coronary artery Bypass grafting were randomized to operation with the Cardiopulmonary Bypass surface either completely heparin coated (Duraflo II) or uncoated. There were 12 patients in each group. Blood plasma sampled during Cardiopulmonary Bypass was analyzed for complement activation (C3bc and terminal SC5b-9 complement complex) and neutrophil activation (lactoferrin and myeloperoxidase). In addition, neutrophils, monocytes, and platelets were counted, and the expression of surface markers on the neutrophils and monocytes (complement receptor [CR] 1, CR3, CR4, and L-selectin) and on the platelets (P-selectin and CD41) was quantified with flow cytometry. Results . Clinical and surgical results were similar in both groups. In the group with the heparin-coated surface, the formation of the terminal SC5b-9 complement complex was significantly reduced, and the counts of circulating leukocytes and platelets were significantly less reduced initially but were higher at the end of Cardiopulmonary Bypass compared with baseline. Also, the expression of CR1, CR3, and CR4 was significantly less upregulated and the L-selectin, significantly less downregulated on monocytes and neutrophils. Conclusions . We conclude that heparin coating reduces complement activation and attenuates the leukocyte integrin and selectin response that occurs when uncoated circuits are used. (Ann Thorac Surg 1997;63:105–11)

Erik Fosse - One of the best experts on this subject based on the ideXlab platform.

  • heparin coated Cardiopulmonary Bypass Equipment ii mechanisms for reduced complement activation in vivo
    The Journal of Thoracic and Cardiovascular Surgery, 1999
    Co-Authors: Vibeke Videm, Tom Eirik Mollnes, Kare Bergh, Erik Fosse, Brit Mohr, Torarne Hagve, A O Aasen, Jan L Svennevig
    Abstract:

    Abstract Objective: Our objective was to study mechanisms for reduced complement activation by heparin coating of Cardiopulmonary Bypass Equipment in clinical heart surgery. Methods: Adults undergoing elective coronary artery Bypass grafting were randomized to Cardiopulmonary Bypass with Duraflo II heparin-coated (n = 15) or uncoated (n = 14) sets (Duraflo coating surface; Baxter International, Inc, Deerfield, Ill). Blood samples were analyzed with the use of enzyme immunoassays for C1rs-C1 inhibitor complexes and the activation products Bb, C4bc, C3bc, C5a-desArg, and the terminal complement complex. Data were compared by repeated-measures analysis of variance. Results : C1 was activated during Bypass, and increases in C1rs-C1 inhibitor complexes were larger with heparin coating ( P = .03). C4bc increased after administration of protamine, without intergroup differences ( P = .69). Bb ( P = .22) and C5a-desArg ( P = .13) tended to increase less with heparin coating. Formation of C3bc ( P = .03) and the terminal complement complex ( P R = 0.6, P R P > .8). Conclusions : C1 activation during Bypass was increased by heparin coating, but further classical pathway activation was held in check until administration of protamine. Heparin coating significantly inhibited C3bc and terminal complement complex formation. Terminal complement complex concentrations were related to alternative pathway activation and may be useful for evaluation of differences in Bypass circuitry. Increases and intergroup differences in terminal complement complex concentrations were much larger than those in C5a-desArg. (J Thorac Cardiovasc Surg 1999;117:803-9)

  • heparin coated Cardiopulmonary Bypass Equipment i biocompatibility markers and development of complications in a high risk population
    The Journal of Thoracic and Cardiovascular Surgery, 1999
    Co-Authors: Vibeke Videm, Tom Eirik Mollnes, Kare Bergh, Erik Fosse, Brit Mohr, Torarne Hagve, A O Aasen, Jan L Svennevig
    Abstract:

    Abstract Objectives: 1. To study possible clinical benefits of heparin-coated Cardiopulmonary Bypass in patients with a broad range of preoperative risk factors. 2. To evaluate the correlation between the terminal complement complex and clinical outcome. 3. To identify clinical predictors of complement activation and correlates of granulocyte activation during cardiac surgery. Methods : Blood samples from adults undergoing elective cardiac surgery with Duraflo II heparin-coated (n = 81) or uncoated (n = 75) Cardiopulmonary Bypass sets (Duraflo coating surface; Baxter International, Inc, Deerfield, Ill) were analyzed for activation of complement (C3 activation products, terminal complement complex), granulocytes (myeloperoxidase, lactoferrin), and platelets (β-thromboglobulin) by enzyme immunoassays. Preoperative risk was assessed by means of the "Higgins' score." Complications (cardiac, renal, pulmonary, gastrointestinal, and central nervous system dysfunction, infections, death) were registered prospectively. Data were analyzed by analysis of variance, logistic regression, and linear regression. Results and conclusions : Sixty-seven percent of the patients had predefined risk factors. Complications developed in 53 patients (34%), equivalently with and without heparin-coated Bypass sets ( P = .44-.82), despite a significant reduction in complement and granulocyte activation by heparin coating. No clear-cut relationship between the terminal complement complex and outcome was found, even if it was significant in the models for renal and central nervous system dysfunction and infections ( P = .006). The Higgins' score was significantly related to complement activation ( P P ≤ .01) and platelet activation ( P P = .02), duration of Cardiopulmonary Bypass ( P P

  • Attenuation of changes in leukocyte surface markers and complement activation with heparin-coated Cardiopulmonary Bypass.
    The Annals of Thoracic Surgery, 1997
    Co-Authors: Oddvar Moen, Erik Fosse, Per Venge, Kolbjørn Høgåsen, Einar Dregelid, Vibeke Brockmeier, Morten Harboe, Tom Eirik Mollnes
    Abstract:

    Abstract Background . The inflammatory response induced by Cardiopulmonary Bypass can result in severe organ dysfunction in some patients. This postperfusion response is caused mainly by contact between blood and the foreign surface of the Cardiopulmonary Bypass Equipment and includes adhesion of leukocytes to vascular endothelium, which precedes a series of events that mediate inflammatory damage to tissues. Methods . Low-risk patients accepted for coronary artery Bypass grafting were randomized to operation with the Cardiopulmonary Bypass surface either completely heparin coated (Duraflo II) or uncoated. There were 12 patients in each group. Blood plasma sampled during Cardiopulmonary Bypass was analyzed for complement activation (C3bc and terminal SC5b-9 complement complex) and neutrophil activation (lactoferrin and myeloperoxidase). In addition, neutrophils, monocytes, and platelets were counted, and the expression of surface markers on the neutrophils and monocytes (complement receptor [CR] 1, CR3, CR4, and L-selectin) and on the platelets (P-selectin and CD41) was quantified with flow cytometry. Results . Clinical and surgical results were similar in both groups. In the group with the heparin-coated surface, the formation of the terminal SC5b-9 complement complex was significantly reduced, and the counts of circulating leukocytes and platelets were significantly less reduced initially but were higher at the end of Cardiopulmonary Bypass compared with baseline. Also, the expression of CR1, CR3, and CR4 was significantly less upregulated and the L-selectin, significantly less downregulated on monocytes and neutrophils. Conclusions . We conclude that heparin coating reduces complement activation and attenuates the leukocyte integrin and selectin response that occurs when uncoated circuits are used. (Ann Thorac Surg 1997;63:105–11)