title: A clinical, renal and immunological assessment of surface modifying additive treated (SMART) cardiopulmonary bypass circuits.
abstract: 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.
authors.affiliation: Department of Anaesthetics and Intensive Care Medicine, The Queen's University of Belfast, Belfast, Northern Ireland. jsdallen@yahoo.com
authors.forename: Stephen
authors.initials: S
authors.lastname: Allen
authors.forename: William T
authors.initials: WT
authors.lastname: McBride
authors.forename: Ian S
authors.initials: IS
authors.lastname: Young
authors.forename: Simon W
authors.initials: SW
authors.lastname: MacGowan
authors.forename: Terence J
authors.initials: TJ
authors.lastname: McMurray
authors.forename: Sachin
authors.initials: S
authors.lastname: Prabhu
authors.forename: S Prasad
authors.initials: SP
authors.lastname: Penugonda
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Armstrong
mesh_terms: 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
chemical_list: D000510:Alpha-Globulins; D020099:Coated Materials, Biocompatible; D016207:Cytokines; C016001:alpha-1-microglobulin; D016753:Interleukin-10