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.
Ovrum
E
E
Department of Cardiac Surgery and Anesthesiology, Oslo Heart Center, Norway.
Mollnes
T E
TE
Fosse
E
E
Holen
E A
EA
Tangen
G
G
Abdelnoor
M
M
Ringdal
M A
MA
Oystese
R
R
Venge
P
P
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