Reduced complement activation and improved postoperative performance after cardiopulmonary bypass with heparin-coated circuits.
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.
Jansen
P G
PG
Center for Cardiopulmonary Surgery Amsterdam, Free University Hospital, The Netherlands.
te Velthuis
H
H
Huybregts
R A
RA
Paulus
R
R
Bulder
E R
ER
van der Spoel
H I
HI
Bezemer
P D
PD
Slaats
E H
EH
Eijsman
L
L
Wildevuur
C R
CR
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
D015938:Complement Membrane Attack Complex; D006493:Heparin; D010196:Pancreatic Elastase; D019272:Leukocyte Elastase