Heparin-coated cardiopulmonary bypass circuits: current status.
Heparin-coated circuits have been subjected to vigorous testing, both experimentally and clinically, for the past decade. When the functions of heparin are preserved on the surface, the heparinized surface plays multiple roles in attenuating the systemic inflammatory response. These include the ability to attenuate contact activation, coagulation activation, complement activation and, directly or indirectly, platelet and leukocyte activation. The heparinized surface also renders the cardiopulmonary bypass (CPB) circuits hydrophilic and protein resistant and augments lipoprotein binding. The multifunctional nature of the heparinized surface contributes to the overall biocompatibility of the surface. Clinically, heparin-coated circuits become most effective in reducing systemic inflammatory response and in improving morbidity, mortality, and other patient outcome related parameters when material-independent blood activation is controlled or minimized through a global biocompatibility strategy. Techniques involved in the global biocompatibility strategy are readily available and are being effectively and safely practiced at several centers. With the global biocompatibility strategy, outstanding and reproducible results have been routinely achieved with conventional CPB techniques. Alternative revascularization procedures should equal or surpass conventional CPB, using best clinically proven strategies with respect to patient outcome and long-term graft patency.
Hsu
L C
LC
Edwards Lifesciences LLC, Irvine, California, USA. LCHsu@therox.com
D000925:Anticoagulants / Q000494:pharmacology*; D000990:Antithrombin III; D001777:Blood Coagulation / Q000187:drug effects; D001779:Blood Coagulation Factors / Q000378:metabolism; D001804:Blood Transfusion, Autologous; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation*; D002986:Clinical Trials as Topic; D020099:Coated Materials, Biocompatible; D003167:Complement Activation / Q000187:drug effects; D016207:Cytokines / Q000378:metabolism; D005342:Fibrinolysis; D006493:Heparin / Q000494:pharmacology*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D015337:Multicenter Studies as Topic; D010447:Peptide Hydrolases / Q000097:blood; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D013396:Suction; D013499:Surface Properties; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control; D010959:Tissue Plasminogen Activator / Q000502:physiology; D016896:Treatment Outcome
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D020099:Coated Materials, Biocompatible; D016207:Cytokines; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D006493:Heparin; D010447:Peptide Hydrolases; D010959:Tissue Plasminogen Activator