Clinical experience with heparin-coated cardiopulmonary bypass circuits.
The extensive area of contact between blood and synthetic surfaces during cardiopulmonary bypass results in the activation of the kallikrein, the complement and the clotting and fibrinolytic systems. This results in white cell activation and a whole body inflammatory response.  Pulmonary neutrophil sequestration is also known to occur during cardiopulmonary bypass and has been associated with pulmonary damage.  This has been previously demonstrated using the technique of differential neutrophil counts in simultaneous venous and left atrial samples.  The efficacy of retinal fluorescein angiography as an indicator of cerebral microembolism has also been proved in previous studies.  The objectives of this study were to determine whether heparin precoating with Duraflo II reduced pulmonary neutrophil sequestration, retinal microembolism and postoperative blood loss. Fourteen patients were randomized into two groups using either heparin-coated or nonheparin-coated cardiopulmonary bypass circuits. The preliminary results suggest a reduction in pulmonary neutrophil sequestration (p greater than 0.05) and the generation of thrombin antithrombin complexes (p less than 0.05).  Retinal microembolism was not significantly different in the two groups nor was the postoperative blood loss.  Thus, heparin-coated cardiopulmonary bypass circuits do not reduce pulmonary neutrophil sequestration, retinal microembolism or postoperative blood loss.
Department of Cardiothoracic Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London.
M J
MJ
Pradhan
J S
JS
Fleming
U U
UU
Nkere
J
J
Arnold
C R
CR
Wildlevuur
K M
KM
Taylor
D001672:Biocompatible Materials; D016063:Blood Loss, Surgical; D002315:Cardiopulmonary Bypass / Q000295:instrumentation* / Q000379:methods; D003167:Complement Activation / Q000187:drug effects; D003176:Complement C3 / Q000032:analysis; D005451:Fluorescein Angiography; D006493:Heparin; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000097:blood / Q000209:etiology; D009504:Neutrophils / Q000187:drug effects; D010196:Pancreatic Elastase / Q000032:analysis; D012171:Retinal Vessels; D013499:Surface Properties