Clinical and biomaterial evaluation of hyaluronan-based heparin-bonded extracorporeal circuits with reduced versus full systemic anticoagulation in reoperation for coronary revascularization.
OBJECTIVE
This prospective randomized study compares full and reduced heparinization on novel hyaluronan-based heparin-bonded circuits vs. uncoated controls under challenging clinical setting including biomaterial evaluation.


METHODS
100 patients undergoing reoperation for coronary artery bypass grafting were allocated into two equal groups (n = 50): Group one was treated with hyaluronan-based heparin bonded preconnected circuits (Vision HFOGBS, Gish, California, USA) and Group two with identical uncoated controls (Vision HFO, Gish, USA). In the study group, half of the patients (n = 25) received low-systemic heparin (125 IU/kg, ACT >250 s) or full dose like control group. Blood samples were collected after induction of anesthesia (T1) and heparin administration before cardiopulmonary bypass (CPB) (T2), 15 min after initiation of CPB (T3), before cessation of CPB (T4), 15 min after reversal with protamine (T5), and the first postoperative day at 08: 00 h (T6).


RESULTS
Platelet counts were preserved significantly better at T5, T6 in hyaluronan groups (P < 0.05 vs. control). Serum IL-2 levels were significantly lower at T4, T5 in both hyaluronan groups and C3a levels at T4 and T5 only in low-dose group (P < 0.05). Troponin-T levels in coronary sinus blood demonstrated well preserved myocardium in hyaluronan groups. No significant differences in thrombin-antithrombin levels were observed between full and low-dose heparin groups at any time point. Amount of desorbed protein was 1.41 +/- 0.01 in full and 1.43 +/- 0.01 in low dose vs. 1.78 +/- 0.01 mg/dl in control (P < 0.05).


CONCLUSIONS
Hyaluronan-based heparin-bonded circuits provided better clinical outcome and less inflammatory response compared with uncoated surfaces. Reduced systemic heparinization combined with hyaluronan-based heparin-bonded circuits is feasible and clinically well tolerated.
Gunaydin
Serdar
S
University of Kirikkale, Kirikkale, Turkey. sgunaydin@isnet.net.tr
Farsak
Bora
B
McCusker
Kevin
K
Vijay
Venkataramana
V
Sari
Tamer
T
Onur
M Ali
MA
Gurpinar
Aylin
A
Zorlutuna
Yaman
Y
D000925:Anticoagulants / Q000008:administration & dosage*; D000990:Antithrombin III; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D015926:Complement C3a / Q000378:metabolism; D001026:Coronary Artery Bypass; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006494:Heparin Antagonists / Q000008:administration & dosage; D006801:Humans; D006820:Hyaluronic Acid; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D007376:Interleukin-2 / Q000097:blood; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000097:blood; D010976:Platelet Count; D011446:Prospective Studies; D011479:Protamines / Q000008:administration & dosage; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D006494:Heparin Antagonists; C508594:IL2 protein, human; D007376:Interleukin-2; D011479:Protamines; D020107:Troponin T; C046193:antithrombin III-protease complex; D015926:Complement C3a; D000990:Antithrombin III; D006820:Hyaluronic Acid; D006493:Heparin; D010447:Peptide Hydrolases