Coating-techniques to improve the hemocompatibility of artificial devices used for extracorporeal circulation.
OBJECTIVE
Extracorporeal circulation procedures have been shown to induce complement and leukocyte activation, release of endotoxin and inflammatory mediators, including cytokines, nitric oxide, oxygen free radicals, and platelet activating factors. The contact between the blood and the various artificial surfaces of the extracorporeal system results in an unspecific post-perfusion syndrome. For diminishing these negative side effects several coating-techniques have been developed to create devices with improved hemocompatibility.


METHODS
This review deals with the current knowledge of heparin-coated and otherwise surface-modified perfusion systems. The pathway how heparin-coated surfaces work is discussed and techniques for surface-coatings, both clinically introduced as well as newly developed are presented.


RESULTS
Numerous clinical studies compared heparin-coated versus non-coated circuits. Heparin-bonded devices showed lessened humoral and cellular activation, in particular a reduced complement activation with a reduced inflammatory post-perfusion syndrome. Also platelet protection and more favorable post-operative lung function are of particular note. Recent clinical trials demonstrated shortened hospital stays, less drainage bleeding, and reduced cerebral complications using heparin-coated oxygenation systems. The diminished expression of the leukocyte adhesion molecules CD 11b/c in CBAS devices points to a decreased activation of neutrophils. In addition, one research group found a reduced production of oxygen radicals. Heparin-bonding minimizes oxygenator failure by a significant reduced pressure gradient across the oxygenator, probably caused by decreased fibrin and platelet deposition at the hollow fiber surfaces. A meta analysis examined the impact of heparin-bonded systems on clinical outcomes and resulting costs. Using heparin-bonded circuits led to total cost savings from US $1000 to 3000. Several authors demonstrated reduced blood loss and better clinical outcome by reduction of systemic heparinization and the employment of heparin-coated devices.


CONCLUSIONS
Above and beyond the long-term applications, routine heart operations have also markedly begun to utilize heparin-coated devices. This trend will assuredly continue in the coming years and is an important step toward higher hemocompatibility of blood-contacting surfaces in the ECC device. Heparin-coatings are merely the beginning of improved hemocompatibility for all materials that come into contact with human blood or tissues. Intelligent materials with almost completely physiological surfaces will be at the surgeon's disposal within the next few years.
Wendel
H P
HP
Department of Surgery, Eberhard-Karls-University, Tuebingen, Germany. hp.wendel@uni-tuebingen.de
Ziemer
G
G
D000818:Animals; D000925:Anticoagulants / Q000737:chemistry*; D001790:Blood Physiological Phenomena; D020099:Coated Materials, Biocompatible; D003327:Coronary Disease / Q000601:surgery*; D004867:Equipment Design; D004869:Equipment Safety; D005112:Extracorporeal Circulation / Q000295:instrumentation* / Q000379:methods; D006493:Heparin / Q000737:chemistry*; D006801:Humans; D008422:Materials Testing; D012680:Sensitivity and Specificity
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D006493:Heparin