title: Reduced complement activation and improved postoperative performance after cardiopulmonary bypass with heparin-coated circuits.
abstract: A randomized controlled trial that involved 30 patients undergoing elective coronary artery bypass grafting was done to determine the effect of heparin-coated circuits and full heparinization on complement activation, neutrophil-mediated inflammatory response, and postoperative clinical recovery. Peak concentrations of terminal complement complex were 38% lower (p = 0.004) in 15 patients treated with heparin-coated circuits (median 775 micrograms/L, interquartile range 600 to 996) compared with those in 15 patients treated with uncoated circuits (median 1249 micrograms/L, interquartile range 988 to 1443). Although no significant intergroup differences in concentrations of polymorphonuclear neutrophil elastase were found, a positive correlation (rs = 0.74, p < 0.0007) was calculated between peak concentrations of terminal complement complex and polymorphonuclear neutrophil elastase. Differences in patient recovery were analyzed with use of a score composed of fluid balance, postoperative intubation time, and the difference between rectal temperature and skin temperature. The score was significantly lower in patients treated with heparin-coated circuits (p = 0.03), whereas its components showed no intergroup significance. We conclude that the use of heparin-coated circuits with full systemic heparinization results in improved biocompatibility, as assessed by complement activation, and leads to an improved postoperative recovery of the patient.
authors.affiliation: Center for Cardiopulmonary Surgery Amsterdam, Free University Hospital, The Netherlands.
authors.forename: P G
authors.initials: PG
authors.lastname: Jansen
authors.forename: H
authors.initials: H
authors.lastname: te Velthuis
authors.forename: R A
authors.initials: RA
authors.lastname: Huybregts
authors.forename: R
authors.initials: R
authors.lastname: Paulus
authors.forename: E R
authors.initials: ER
authors.lastname: Bulder
authors.forename: H I
authors.initials: HI
authors.lastname: van der Spoel
authors.forename: P D
authors.initials: PD
authors.lastname: Bezemer
authors.forename: E H
authors.initials: EH
authors.lastname: Slaats
authors.forename: L
authors.initials: L
authors.lastname: Eijsman
authors.forename: C R
authors.initials: CR
authors.lastname: Wildevuur
mesh_terms: D001831:Body Temperature; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003167:Complement Activation; D015938:Complement Membrane Attack Complex / Q000378:metabolism; D001026:Coronary Artery Bypass; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007442:Intubation, Intratracheal; D019272:Leukocyte Elastase; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000201:enzymology; D010196:Pancreatic Elastase / Q000097:blood; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D012121:Respiration, Artificial; D012881:Skin Temperature; D013997:Time Factors; D014882:Water-Electrolyte Balance
chemical_list: D015938:Complement Membrane Attack Complex; D006493:Heparin; D010196:Pancreatic Elastase; D019272:Leukocyte Elastase