ENDOTHELIN-1 AND NEUTROPHIL ACTIVATION DURING HEPARIN-COATED CARDIOPULMONARY BYPASS

Background. Heparin-coated circuits attenuate the systemic inflammator y response to cardiopulmonary bypass. The present study compares two d ifferent heparin coatings in terms of the release of endothelin-1 and neutrophil glycoproteins. Methods. Forty low-risk patients undergoing coronary artery bypass grafting were investigated, having cardiopulmon ary bypass with a Duraflo II heparin-coated circuit (n = 10), an ident ical but uncoated circuit (n = 10), a Carmeda BioActive Surface hepari n-coated circuit (n 10), or an identical but uncoated circuit (n = 10) . A standard systemic heparin dosage was used in all patients. Endothe lin-1 and the neutrophil glycoproteins lactoferrin and myeloperoxidase were quantified throughout the operation and 3 hours postoperatively. Results. Enhanced plasma levels of endothelin-1, lactoferrin, and mye loperoxidase were observed during and after uncoated cardiopulmonary b ypass, but this was not associated with clinical side effects. Compare d with the respective uncoated controls, Duraflo II attenuated only th e lactoferrin levels, whereas Carmeda BioActive Surface was associated with lower levels of both endothelin-1, lactoferrin, and myeloperoxid ase. Of the two heparin coatings, Carmeda BioActive Surface proved mor e effective than Duraflo II in attenuating the levels of these substan ces. Conclusions. The plasma levels of endothelin-1, lactoferrin, and myeloperoxidase increase during cardiopulmonary bypass in coronary art ery bypass grafting, but this has no clinical side effects in low-risk patients. The increase is attenuated using heparin-coated extracorpor eal circuits, and then more effectively by Carmeda BioActive Surface t han by Duraflo II. (C) 1997 by The Society of Thoracic Surgeons.