A clinical, renal and immunological assessment of surface modifying additive treated (SMART) cardiopulmonary bypass circuits.
Biocompatible cardiopulmonary bypass (CPB) circuits aim to reduce contact activation and its physiological consequences. We investigated the hypothesis that use of Surface Modifying Additive (SMA)-treated circuits (Sorin Group Ltd) compared with non-SMA circuits would be associated with preservation of blood pressure during CPB and modulation of perioperative subclinical renal function (urinary alpha-1-microglobulin (alpha-1-m)) and plasma and urinary cytokine changes. In a study of low-risk CABG patients (n=40), randomized to SMA (n=20) versus non-SMA circuits (n=20), we found better preserved blood pressure at CPB initiation in SMA patients (p <0.05), particularly in ACE-inhibited SMA patients (n =11) versus ACE-inhibited non-SMA patients (n =10) (p <0.05). Plasma anti-inflammatory IL-10, as well as urinary alpha-1-m, were elevated 48 hours postoperatively (p <0.05). SMA patients also had lower blood loss (p <0.05). SMA circuits have some clinical benefit, especially in ACE-inhibited patients.
Allen
Stephen
S
Department of Anaesthetics and Intensive Care Medicine, The Queen's University of Belfast, Belfast, Northern Ireland. jsdallen@yahoo.com
McBride
William T
WT
Young
Ian S
IS
MacGowan
Simon W
SW
McMurray
Terence J
TJ
Prabhu
Sachin
S
Penugonda
S Prasad
SP
Armstrong
Marilyn A
MA
D000368:Aged; D000510:Alpha-Globulins / Q000652:urine; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001794:Blood Pressure; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible / Q000592:standards* / Q000627:therapeutic use; D016207:Cytokines / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D007431:Intraoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged
D000510:Alpha-Globulins; D020099:Coated Materials, Biocompatible; D016207:Cytokines; C016001:alpha-1-microglobulin; D016753:Interleukin-10