G. Wimmer-greinecker et al., Synthetic protein treated versus heparin coated cardiopulmonary bypass surfaces: similar clinical results and minor biochemical differences, EUR J CAR-T, 16(2), 1999, pp. 211-217
Objective: Complications associated with cardiopulmonary bypass (CPB) have
gained more attention due to increased interest in coronary artery bypass g
rafting without CPB. The impact of heparin coating of CPB circuits has been
discussed controversially. The present study examines if the treatment of
the oxygenator surface with a synthetic protein may serve as an alternative
to a completely heparin coated circuit. Methods: Fifty-eight patients unde
rgoing coronary artery bypass grafting with CPB were randomly assigned to c
ompletely heparin coated circuits or synthetic protein treated oxygenators
in a double blind protocol, focussing on the inflammatory reaction resultin
g in membrane damage, coagulation changes and markers of cerebral injury or
dysfunction. Treatment groups did not differ as to preoperative demographi
cs, and intraoperative clinical data. Patients with any neurologic disease
or risk factors for cerebral dysfunction were not included in the study. Re
sults: Postoperative clinical data did not differ between groups. Both surf
ace treatments resulted in similar coagulation activation, hyperfibrinolysi
s and disseminated intravascular coagulation. Platelet count displayed a di
fference in favour of the heparin coated group (P = 0.029), Increased leuko
cyte activation reflected by rising myeloperoxidase concentrations on CPB w
as present in both synthetic protein and heparin coating groups. Interleuki
ns 6 and 8 reacted similarly, but interleukin 8 increased significantly mor
e (P = 0.0061) at the end of surgery in patients treated with protein treat
ed oxygenators. The same pattern was observed for complement activation as
determined by total complement complex (P = 0.006). Both surface changes re
sulted in moderately increased S-100B protein and neuron specific enolase,
without difference between groups. Both markers did not reach concentration
s associated with clinical manifestation of cerebral injury. Conclusions: T
hese results in routine patients with short bypass time, imply that protein
treated oxygenators are associated with a limited increase of biochemical
markers similar to heparin coating. However, significantly lower interleuki
n 8 release and complement activation can be achieved by heparin coating. T
he protein treatment is a standard feature of the oxygenator examined in bo
th groups. it is not associated with additional cost and therefore appropri
ate for use in routine patients. (C) 1999 Elsevier Science B.V. All rights
reserved.