Heparin-coated circuits reduce occult myocardial damage during CPB: a randomized, single blind clinical trial.
OBJECTIVE
Cardiopulmonary bypass is associated with a diffuse systemic inflammatory response that can cause considerable morbidity, including organ dysfunction and bleeding. Heparin-coated circuits have been shown to give a reduced inflammatory response with clinical benefits during open-heart surgery. However, the effects on lipid peroxidation, neutrophil activation and myocardial ischemic damage in the human have remained unknown.


METHODS
In a randomized single blind trial, complement activation, neutrophil counts, malondialdehyde, and cardiac enzymes were studied in 39 patients undergoing open-heart surgery. Two groups were perfused with cardiopulmonary bypass circuits with (n=20) or without heparin-coating (n=19).


RESULTS
The different complement factors (C3, C4, C3d, C3d/C3 and the C-function), neutrophil levels, MDA and the cardiac enzyme levels were comparable before CPB was started and significantly increased in both groups during bypass. There were significant intergroup differences in the neutrophil levels and MDA after reperfusion (P<0.0001). Furthermore, significant positive correlations between the lipid peroxidation, expressed as MDA levels, and the levels of neutrofils and the cardiac enzyme, CK-MB were seen within the groups.


CONCLUSIONS
Heparin coated circuits did lead to a decreased neutrophil response and MDA level. The correlations between CK-MB and neutrophil and MDA levels suggest neutrophil activation leading to lipid peroxidation that may influence myocardial damage. Heparin coating improved biocompatibility and was associated with less occult myocardial ischemic damage in patients undergoing open heart surgery.
Belboul
A
A
Department of Cardiothoracic Surgery, University of Gothenburg, Sahlgrenska University Hospital, SE 413 45, Gothenburg, Sweden. ali.belboul@sahlgrenska.se
Löfgren
C
C
Storm
C
C
Jungbeck
M
M
D000368:Aged; D001219:Aspartate Aminotransferases / Q000032:analysis; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D003167:Complement Activation; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000032:analysis; D005260:Female; D006493:Heparin; D006801:Humans; D007527:Isoenzymes; D015227:Lipid Peroxidation; D008297:Male; D008315:Malondialdehyde / Q000032:analysis; D008875:Middle Aged; D016037:Single-Blind Method
D020099:Coated Materials, Biocompatible; D007527:Isoenzymes; D008315:Malondialdehyde; D006493:Heparin; D001219:Aspartate Aminotransferases; D003402:Creatine Kinase