Phosphorylcholine-coated circuits improve preservation of platelet count and reduce expression of proinflammatory cytokines in CABG: a prospective randomized trial.
BACKGROUND
The interaction of blood with foreign artificial surfaces during cardiopulmonary bypass (CPB) has been recognized as a major stimulus in evoking a systemic inflammatory and metabolic response. Phosphorylcholine (PC) is a new-generation coating material designed to ameliorate biocompatibility and thereby to reduce the detrimental interactions of CPB. We studied the effects of PC-coated perfusion circuits on platelet function and the humoral and cellular response to CPB.


METHODS
Thirty patients undergoing coronary artery bypass grafting were randomized to PC-coated (PC group, n = 15) and noncoated (control group, n = 15) circuit groups. Clinical data, total blood loss, and pre- and postoperative platelet counts were recorded and IL-6 and TNF-alpha, CD41a, CD42b, and CD62p were measured at induction of anesthesia, after the initiation of CPB and at termination of CPB.


RESULTS
There was a significantly improved preservation of platelet count following CPB in the PC group (p = 0.028), which was sustained over a period of 72 hours. The use of PC-coated circuits further resulted in a significant attenuation of TNF-alpha and IL-6 expression (p < 0.05 and p < 0.01); however, we were unable to detect any differences in clinical outcomes.


CONCLUSIONS
Despite similar clinical outcome, the obvious reduction of cytokine expression and improved preservation of platelet count suggest superior biocompatibility of PC-coated circuits.
Schulze
Costas J
CJ
Division of Cardiothoracic Surgery, Department of Laboratory Medicine and Pathology, University of Alberta, 8440-112 Street, Edmonton, Alberta, Canada.
Han
Lin
L
Ghorpade
Nitin
N
Etches
Wai S
WS
Stang
Linda
L
Koshal
Arvind
A
Wang
Shao Hua
SH
D000368:Aged; D020099:Coated Materials, Biocompatible; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D010767:Phosphorylcholine; D010976:Platelet Count; D019038:Platelet Glycoprotein GPIb-IX Complex; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000517:prevention & control; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D020099:Coated Materials, Biocompatible; D015850:Interleukin-6; D019007:P-Selectin; D019038:Platelet Glycoprotein GPIb-IX Complex; D014409:Tumor Necrosis Factor-alpha; D010767:Phosphorylcholine