Complement and granulocyte activation in two different types of heparinized extracorporeal circuits.
Complement and granulocyte activation were studied in cardiopulmonary bypass circuits completely coated with either end-attached covalent-bonded heparin, the Carmeda BioActive Surface, or with the Duraflo II bonded heparin, in combination with reduced systemic heparinization (activated clotting time > 250 seconds). The control groups were perfused with uncoated circuits and full heparin dose (activated clotting time > 480 seconds). Altogether 67 patients undergoing elective first-time myocardial revascularization were investigated, having extracorporeal perfusion with a Duraflo II coated circuit (n = 17), an identical but uncoated circuit (n = 17), a Carmeda coated circuit (n = 17), or an equivalent uncoated circuit (n = 16). During cardiopulmonary bypass, the C3 activation products C3b, iC3b, and C3c (C3bc) and the terminal SC5b-9 complemented complex increased markedly in all four groups compared with baseline, but significantly less in the two coated groups than in their control groups. Additionally, a significantly lower concentration of C3bc was observed in the Carmeda coated group, with maximal increase of median 28 AU/ml compared with 50 AU/ml in the Duraflo II coated group (p = 0.003). Similarly, in the Carmeda coated group, the maximal increase of terminal complement complex was considerably lower (0.8 AU/ml) than the levels recognized in the Duraflo II coated group (2.4 AU/ml) (p < 0.001). The release of the granulocyte activation myeloperoxidase and lactoferrin increased from the beginning of the operation, with peak levels at the end of bypass. A significant reduction of lactoferrin release was recognized when comparing the coated groups with the control groups. The difference between the two coated groups (Carmeda 228 micrograms/L; Duraflo II 332 micrograms/L; p = 0.05) was marginally significant. For myeloperoxidase, no significant differences were observed between the coated and uncoated groups. In conclusion, both types of heparin-coated circuits reduced complement activation and release of lactoferrin, but the Carmeda circuit proved to be more effective than the Duraflo II equipment.
Department of Cardiac Surgery and Anesthesiology, Oslo Heart Center, Norway.
E
E
Ovrum
T E
TE
Mollnes
E
E
Fosse
E A
EA
Holen
G
G
Tangen
M
M
Abdelnoor
M A
MA
Ringdal
R
R
Oystese
P
P
Venge
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation*; D003167:Complement Activation; D003176:Complement C3 / Q000032:analysis; D015938:Complement Membrane Attack Complex / Q000032:analysis; D001026:Coronary Artery Bypass; D017558:Elective Surgical Procedures; D005260:Female; D006098:Granulocytes / Q000276:immunology*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007781:Lactoferrin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009195:Peroxidase / Q000097:blood; D013499:Surface Properties
D003176:Complement C3; D015938:Complement Membrane Attack Complex; D006493:Heparin; D009195:Peroxidase; D007781:Lactoferrin