title: The impact of heparin coated circuits upon metabolism in vital organs: effect upon cerebral and renal function during and after cardiopulmonary bypass.
abstract: During cardiopulmonary bypass (CPB), the brain and the kidneys may be damaged because of microemboli, ischemia, and inflammation. The latter has been reduced by the use of heparin coated circuits. We questioned whether heparin coated circuits could also reduce cerebral and renal damage and whether inflammatory markers correlate with damage to the brain and the kidneys. Fifty-one patients scheduled for coronary artery bypass grafting were perfused with either a heparin coated or an uncoated circuit. To compare the effect of a heparin coated circuit with an uncoated circuit upon cerebral and renal function in relation to inflammation, we assessed markers of cerebral (S100beta) and renal (N-acetyl-beta-D-glucosaminidase [NAG], creatinine, and urea) function, inflammation, and oxygen metabolism. S100beta levels and NAG levels increased during CPB in both groups as compared with baseline levels (p < 0.01), without differences between the groups. After 15 minutes on CPB, C4b/c levels were significantly higher in the coated group compared with the uncoated group (p < 0.02). C4b/c correlated with S100beta (p < 0.01). Total body oxygen delivery (DO2) and consumption (VO2) decreased significantly in both groups during CPB (p < 0.01), but recovery was better in the coated group. After protamine infusion, total body oxygen delivery and consumption correlated negatively with S100beta levels (both p < 0.05) and with NAG levels (both p < 0.01). This study suggests that, if adequate tissue perfusion is not maintained, the use of a heparin coated circuit gives no additional benefit beyond that of the uncoated circuit. The inverse relationship of both cerebral and renal markers with DO2 and VO2 suggests that increased levels of S100beta and NAG during CPB may primarily be caused by an oxygen deficit and secondary to the inflammatory response.
authors.affiliation: Department of Extracorporeal Circulation, Room 6A 149, Vrije Universiteit Medisch Centrum, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: Roel
authors.initials: R
authors.lastname: de Vroege
authors.forename: Wim
authors.initials: W
authors.lastname: Stooker
authors.forename: Wim
authors.initials: W
authors.lastname: van Oeveren
authors.forename: Edwin W M
authors.initials: EW
authors.lastname: Bakker
authors.forename: Rien A J M
authors.initials: RA
authors.lastname: Huybregts
authors.forename: Jan
authors.initials: J
authors.lastname: van Klarenbosch
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: van Kamp
authors.forename: C Erik
authors.initials: CE
authors.lastname: Hack
authors.forename: Leon
authors.initials: L
authors.lastname: Eijsman
authors.forename: Charles R H
authors.initials: CR
authors.lastname: Wildevuur
mesh_terms: D000118:Acetylglucosaminidase / Q000378:metabolism; D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use*; D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D001921:Brain / Q000187:drug effects* / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods*; D020099:Coated Materials, Biocompatible / Q000494:pharmacology / Q000627:therapeutic use*; D003404:Creatinine / Q000378:metabolism; D004311:Double-Blind Method; D005112:Extracorporeal Circulation; D005260:Female; D006493:Heparin / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007249:Inflammation; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D018579:Patient Selection; D009418:S100 Proteins / Q000378:metabolism; D014508:Urea / Q000378:metabolism
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D020099:Coated Materials, Biocompatible; D009418:S100 Proteins; D014508:Urea; D006493:Heparin; D003404:Creatinine; D000118:Acetylglucosaminidase; D010100:Oxygen